Clinical and Biochemical Tests Suggesting Malignancy

Some features of a nonmetastatic adrenal tumor, regardless of the size, are highly suggestive of malignancy, especially if combined. These are as follows: Clinical

Abrupt onset of disease Pyrexia

Abdominal pain Abdominal mass

Inferior vena caval compression or obstruction Associated breast carcinoma, osteosarcomas, or brain tumors (Li-Fraumeni syndrome) Clinical and biochemical Mixed hormone secretion

Mild androgenic changes (an indication of the secretion of precursors) Feminizing syndrome Ectopic secretion syndrome Biochemical

Urinary ketosteroid production in excess of 30 to 40 mg/day

Elevated dehydroepiandrosterone levels observed in 80% of cases4

Inactive precursor secretion, pregnenolone and aldosterone precursors, especially 18-hydroxylated compounds7

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