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Bechmann N, Moskopp ML, Constantinescu G, Stell A, Ernst A, Berthold F, Westermann F, Jiang J, Lui L, Nowak E, Zopp S, Pacak K, Peitzsch M, Schedl A, Reincke M, Beuschlein F, Bornstein SR, Fassnacht M, Eisenhofer G. Asymmetric Adrenals: Sexual Dimorphism of Adrenal Tumors. J Clin Endocrinol Metab 2024; 109:471-482. [PMID: 37647861 PMCID: PMC11032253 DOI: 10.1210/clinem/dgad515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/03/2023] [Accepted: 08/28/2023] [Indexed: 09/01/2023]
Abstract
CONTEXT Sexual dimorphism has direct consequences on the incidence and survival of cancer. Early and accurate diagnosis is crucial to improve prognosis. OBJECTIVE This work aimed to characterized the influence of sex and adrenal asymmetry on the emergence of adrenal tumors. METHODS We conducted a multicenter, observational study involving 8037 patients with adrenal tumors, including adrenocortical carcinoma (ACC), aldosterone-producing adenoma (APA), cortisol-secreting adrenocortical adenomas (CSAs), non-aldosterone-producing adrenal cortical adenoma (NAPACA), pheochromocytoma (PCC), and neuroblastoma (NB), and investigated tumor lateralization according to sex. Human adrenal tissues (n = 20) were analyzed with a multiomics approach that allows determination of gene expression, catecholamine, and steroid contents in a single sample. In addition, we performed a literature review of computed tomography and magnetic resonance imaging-based studies examining adrenal gland size. RESULTS ACC (n = 1858); CSA (n = 68), NAPACA (n = 2174), and PCC (n = 1824) were more common in females than in males (female-to-male ratio: 1.1:1-3.8:1), whereas NBs (n = 2320) and APAs (n = 228) were less prevalent in females (0.8:1). ACC, APA, CSA, NAPACA, and NB occurred more frequently in the left than in the right adrenal (left-to-right ratio: 1.1:1-1.8:1), whereas PCC arose more often in the right than in the left adrenal (0.8:1). In both sexes, the left adrenal was larger than the right adrenal; females have smaller adrenals than males. CONCLUSION Adrenal asymmetry in both sexes may be related to the pathogenesis of adrenal tumors and should be considered during the diagnosis of these tumors.
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Affiliation(s)
- Nicole Bechmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Mats Leif Moskopp
- Department of Neurosurgery, Vivantes Friedrichshain Hospital, Charité Academic Teaching Hospital, 10249 Berlin, Germany
| | - Georgiana Constantinescu
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Anthony Stell
- School of Computing and Information Systems, University of Melbourne, 3052 Melbourne, Australia
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
| | - Frank Berthold
- Children's Hospital, University of Cologne, 50735 Cologne, Germany
| | - Frank Westermann
- Hopp Children's Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany
- Division of Neuroblastoma Genomics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Jingjing Jiang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, 200031 Shanghai, China
| | - Longfei Lui
- Department of Urology, Xiangya Hospital, Central South University, 410017 Changsha, China
| | - Elisabeth Nowak
- Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany
| | - Stephanie Zopp
- Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20892, USA
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Andreas Schedl
- Université Côte d’Azur, Inserm, CNRS, Institut de Biologie Valrose, 06108 Nice, France
| | - Martin Reincke
- Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany
| | - Felix Beuschlein
- Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), 8091 Zurich, Switzerland
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Stefan R Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital of Würzburg, University of Würzburg, 97080 Würzburg, Germany
| | - Graeme Eisenhofer
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
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