[Virilizing adrenal adenoma: a report of a case]

Androgen excess can be due to different entities such as polycystic ovarian syndrome, ovarian tumors or adrenal tumors. It is presented the case of a 26 year-old woman that suffered from amenorrhea, hirsutism, voice deepening, reduction of mammary volume and 10 kg weight loss, without response to different treatments. At physical exam she had hirsutism (24 points, Ferriman-Gallaway) the clitoris had 3 cm length. Laboratory: androstenedione 29.5 ng/mL, DHEAS >1000 microg/dL, T 6.23 ng/mL, 17 OHP 4.9 ng/mL. At pelvic ultrasound the uterus and left ovary were normal, the right ovary had subcortical follicles no greater than 3 mm. The CAT scan and nuclear magnetic imaging of adrenal glands showed an oval retroperitoneal image of 7.2 x 6.5 x 8.4 cm at the right adrenal gland. Surgery was performed and the right adrenal gland excised. The histopathologic report indicated a benign cortical adenoma. The patient's postsurgical evolution was satisfactory with regression of the virilizing signs, with spontaneous return of menstrual periods. Hirsutism can be the initial sign, and even in some occasions the only one of different pathologies. The study of the hyperandrogenic patient should be integral with clinical, hormonal and imaging evaluations to be able to specify the origin of androgen production.