FUNCTIONING ADRENAL TUMORS IN CHILDHOOD: Consideration of Diagnosis, Surgical Approach, and Postoperative Management

THE OCCURRENCE of hormone-producing neoplasms of the adrenal cortex is rare in childhood. Approximately 30 instances of Cushing's syndrome and 55 cases of virilism due to adrenal cortex tumor have been described in children between the ages of 3 months and 10 years.¹ Differential diagnosis may be difficult, and surgery is often hazardous and complicated by postoperative adrenal insufficiency.² This report deals with a child with Cushing's syndrome and one with adrenal virilism and presents a discussion of some of the problems of diagnosis, surgical approach, and postoperative care.

METHODS  Skeletal age was estimated by comparison of a roentgenogram of the hand and wrist with the standards of Todd³ or by the 67-ossification-center survey.⁴ The 17-ketosteroid excretion was determined by the simultaneous hydrolysis and extraction of urine with toluene⁵ and the aqueous alkali colorimetric procedure of Koch.⁶ Dehydroisoandrosterone-like compounds were measured by Allen's adaptation