Increases in cortisol:cortisone ratio at the lower stages could increase estrogen production via activation of aromatase, but at a later stage, decreases in cortisol:cortisone could be explained by a negative feedback loop through increased estrogen production by the tumor and a concomitant lower expression of HSD11B1. However, we were unable to demonstrate a relationship between cortisol:cortisone ratio with E2:E1 ratio or E2 and E1 in our sample, contrary to previous results in visceral adipose tissue, but similar to results in subcutaneous tissue (51). The gene discussed is HSD11B1; the disease is neoplasm.