Detailed clinical, laboratory, radiologic, and pathologic findings are presented, and the pertinent literature is reviewed.
RESULTS: A 49-year-old woman was referred for evaluation of a left adrenal mass (3.0 by 2.4 cm), which had been diagnosed by computed tomographic scan 4 years previously during a work-up for
hirsutism. On examination, she had
central obesity, facial
hirsutism, and
male pattern baldness. Work-up showed elevated total and free
testosterone levels of 196 ng/dL (reference range, 20 to 70) and 24 pg/mL (1 to 9), respectively. Other results (and reference ranges) were as follows:
dehydroepiandrosterone sulfate, 7.5 microg/dL (10 to 221);
corticotropin, 12 pg/mL (5 to 50); morning
cortisol, 1.4 microg/dL after a 1-mg overnight
dexamethasone suppression test; and urine free
cortisol, 48.8 microg/24 h (20 to 100). The
testosterone level decreased by 14% after a 2-day low-dose
dexamethasone suppression test. Findings on transvaginal ovarian ultrasonography and a computed tomographic scan of the pelvis were normal. A laparoscopic
adrenalectomy revealed an adrenal
adenoma. On the first day postoperatively, the
cortisol level was less than 1.0 microg/dL; however, the
testosterone level remained elevated. At 6 months postoperatively, a normal result of a
cosyntropin stimulation test indicated recovery of the hypothalamic-pituitary-adrenal axis. Bilateral
oophorectomy revealed a 1.3-cm right ovarian
Leydig cell tumor. Postoperatively, the
testosterone level declined to less than 20 ng/dL.
CONCLUSION: