Adrenocortical tumors in children: Sri Lankan experience from a single center, and a mini review

BACKGROUND

Pediatric adrenocortical tumors include both benign adenomas and highly virulent malignant tumors. However, they are very rare among children. The aim of this study is to evaluate the clinicopathological data of children presenting with adrenocortical tumors and assess their survival in a South Asian population.

CASE PRESENTATION

This is a retrospective cohort study that includes patients diagnosed with adrenocortical tumors from August 2020 to August 2022 followed-up at Lady Ridgeway Hospital. Seven children were diagnosed with adrenal cortical tumors. Their ages ranged from 10 months to 6.5 years. Five of them were boys. All displayed signs of peripheral precocious puberty. One boy phenotypically had features of Beckwith-Wiedemann syndrome. The median time for diagnosis after the onset of symptoms was 4.4 months. The preoperative diagnosis was based on clinical manifestations, elevated dehydroepiandrosterone sulfate levels, and suprarenal masses on computed tomography. All five boys had right-sided suprarenal masses, while the two girls had them on the left side. All underwent surgery for tumor resection. The diagnosis was confirmed based on the histopathology of the adrenal specimens. Four children had a Wieneke score of 4 or more, suggesting the possibility of adrenocortical carcinoma; however, only two of them behaved as malignant tumors. To date, two children have developed local recurrences within a very short period.

CONCLUSION

Adrenocortical tumors are uncommon in children, and treatment options are limited. To identify early recurrences, routine clinical, radiological, and biochemical examinations at least once every 6-8 weeks is important.

Sitosterolemia-An Underdiagnosed and Heterogeneous Lipid Disorder. A Case Series From a Tertiary Care Centre in Australia

AIMS

Sitosterolemia, is a disorder of increased plant sterol levels leading to a variable presentation and haematological manifestations. Although considered rare, the prevalence is likely underestimated due to the variable phenotype and challenges in diagnosis. The delayed diagnosis may lead to cardiovascular complications. We reviewed the presentation and management of patients with sitosterolemia in our clinic.

METHOD

We report 4 children aged 18 months to 18 years with variable manifestations from xanthomas to haemolytic anaemia who were subsequently confirmed to have sitosterolemia on genetic testing.

RESULTS

One patient presented with xanthomas, two patients with haematological manifestations and the other with an abnormal lipid profile. All patients had a strong family history of lipid disorders and cardiovascular disease at a young age. All patients had confirmatory genetic testing and were managed with dietary adjustments and ezetimibe resulting in improvement of lipid and haematological profiles.

CONCLUSION

Sitosterolemia is a likely underdiagnosed lipid disorder due to variable phenotype and specialised genetic and biochemical diagnostic tests. Early diagnosis and treatment fully reverse the clinical manifestations and associated complications.