Pure testosterone‐producing virilizing adrenocortical tumours in young women

A 33-year-old African-American female (gravida 2, para 1) presented with a a 1.5 year history of excessive hair growth on the face, chest, back and arms. She noted acne on her face and back, with the development of a deep masculine voice. On physical examination she had diffuse hair growth involving her chest, breasts, shoulders, back and abdomen and moderate clitoromegaly. On further evaluation she had an elevated testosterone level of 2.59 mg/L (normal 0.11– 0.78 ng/L), but her 17-hydroxyprogesterone, plasma cortisol and aldosterone levels were normal. MRI showed an enlarged left adrenal gland (6 cm diameter) and no evidence of metastatic disease. She underwent left adrenalectomy; tumour growth was detected into the enlarged adrenal vein with tumour thrombus extending into the renal vein (Fig. 1). Histology showed a malignant adrenal cortical neoplasm. Three months after surgical resection her serum testosterone level was within the normal range, but at 6 months CT of the chest showed several new and enlarging lung nodules, and high-density lesions in the liver, representing metastatic disease. Fine-needle aspiration biopsy of the lung nodules showed features consistent with adrenal cortical neoplasm.