Controversy exists as to which variable is a reliable predictor of clinical outcome of adrenal cortical tumors in children. Twenty patients with adrenal cortical tumors were studied. Eleven patients had Cushing's syndrome with virilization and 9 had virilization without Cushing's syndrome. Histologic features did not correlate with clinical outcome. Histologic features are not adequate predictors of outcome and PCNA may be useful in tumors of patients with Cushing's syndrome, but this parameter should not be used alone.
Divergent recommendations exist regarding the evaluation of adrenal incidentalomas.
These data expand the differential diagnosis of such incidental tumors and substantially modify the approach to their evaluation. We present two patients, female pseudohermaphrodites with the simple virilizing form of CAH and 21-hydroxylase deficiency, who functioned successfully as married phenotypic males. Both came to medical attention in the sixth decade by virtue of massive adrenal incidentalomas encountered in the evaluation of recurrent urinary tract infections. Histologic and autopsy examination of the first patient's tumor and computed tomographic characteristics of the second revealed a benign adenoma and myelolipoma respectively. We extend and confirm previous recommendations that CAH be included in the differential diagnosis of adrenal incidentaloma and that baseline 17-OH Prog.