The asymmetric adrenals: Sexual dimorphism of adrenal tumours
Nicole Bechmann, Mats Leif Moskopp, Georgiana Constantinescu, Anthony Stell, Angela Ernst, Frank Berthold, Frank Westermann, Jingjing Jiang, Longfei Lui, Elisabeth Nowak, Stephanie Zopp, Karel Pacak, Mirko Peitzsch, Andreas Schedl, Martin Reincke, Felix Beuschlein, Stefan R Bornstein, Martin Fassnacht, Graeme Eisenhofer,- Biochemistry (medical)
- Clinical Biochemistry
- Endocrinology
- Biochemistry
- Endocrinology, Diabetes and Metabolism
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 characterised the influence of sex and adrenal asymmetry on the emergence of adrenal tumours.
Methods
We conducted a multicentre, observational study involving 8037 patients with adrenal tumours, including adrenocortical carcinoma (ACC), aldosterone-producing adenoma (APA), cortisol-secreting adrenocortical adenomas (CSAs), non-aldosterone producing adrenal cortical adenoma (NAPACA), phaeochromocytoma and neuroblastoma, and investigated tumour lateralisation according to sex. Human adrenal tissues (n=20) were analysed with a multi-omics 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 phaeochromocytoma (n=1824) were more common in females than in males (female-to-male ratio: 1.1:1 - 3.8:1), while neuroblastomas (n=2320) and APAs (n=228) were less prevalent in females (0.8:1). ACC, APA, CSA, NAPACA and neuroblastoma occurred more frequently in the left than in the right adrenal (left-to-right ratio: 1.1:1–1.8:1), whereas phaeochromocytoma 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, whereby females have smaller adrenals than males.
Conclusion
Adrenal asymmetry in both sexes may be related to the pathogenesis of adrenal tumours and should be considered during the diagnosis of these tumours.