Virilizing and Feminizing Adrenal Tumors

- Rare
- usually symptomatic

>80% are malignant
- almost all feminizing tumors malignant
- 50% of virilizing tumors are malignant

- because they are so rare, testing for sex hormone excess during work-up of incidentaloma should only be done if there are clinical signs of virilization or feminization

Diagnosis:
- Virilizing tumors: serum testosterone, serum dihydroepiandrostenedione, 24 hr urine 7-hydroxysteroid, 24 hr urine 7-ketosteroids (serum androgens and 24 hr urine keto-steroids suppressed if ovarian cause)
- dexamethasone suppression test can differentiate between adrenal and ovarian cause
- Feminizing tumor: serum estrogen and suppressed FSH, LH and gonadotropins confirm feminizing adrenal tumor (as opposed to testicular tumor)
- CT scan can generally localize a tumor

Consider that most are malignant when deciding if going to attempt laparoscopically