Conversion of virilization to feminization in a young girl with adrenal cortical carcinoma

Abstract

A 4‐year‐old girl presented with signs and symptoms of virilization and hypercortisolism. After removal of an adrenal cortical carcinoma and treatment with op'DDD, her clinical picture initially improved. Therapy with the drug was intermittent and varying in dosage since she had bouts of adrenocortical insufficiency requiring replacement therapy with adrenal cortical steroids, and she repeatedly showed signs of drug toxicity. Recurrences of the tumor and mctastases to the lungs and liver were accompanied by rises in 17‐ketosteroid output and feminization. The patient, despite surgical removal of the tumor and hemihepatectomy, died 3 years after the onset of the disease. The unique transition of an androgen‐ and 17‐hydroxycorticoid‐producing adrenal cortical carcinoma into one that caused feminization may have been due to biochemical changes in the tumor itself, or to extra‐adrenal metabolism of adrenal androgens to estrogens under the effect of op'DDD. Copyright © 1971 American Cancer Society