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The Molecular Pathogenesis of Hereditary and Sporadic Adrenocortical and Adrenomedullary Tumors

Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health (C.A.K., K.P., G.P.C.), Bethesda, Maryland 20892; and Department of Medicine III, University of Leipzig (C.A.K.), 04103 Leipzig, Germany

Address all correspondence and requests for reprints to: Christian A. Koch, M.D., FACP, Department of Medicine III, University of Leipzig, Phil.-Rosenthalstrasse 27, 04103 Leipzig, Germany. E-mail: kochc{at}exchange.nih.gov.

Abstract

Modern imaging modalities lead to frequent detection of adrenal masses, most of them incidental findings. Although the majority of adrenocortical and adrenomedullary tumors are benign, there are no reliable clinical and laboratory markers to distinguish most of them from malignant neoplasms. The molecular mechanisms underlying the pathogenesis of these tumors have recently begun to be unraveled. A fruitful avenue for the elucidation of tumorigenesis has been the study of adrenal tumors that are manifestations of hereditary or postzygotic genetic syndromes, because one knows the "first hit", i.e. the primary gene defect. In contrast, in sporadic adrenal tumors the first hit, possibly a somatic mutation of a tumor-related gene, is unknown, and therefore the sequence of genetic alterations is difficult to establish. In this article we review in addition to our own work the literature on molecular aspects of adrenocortical and adrenomedullary tumorigenesis.

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