An adrenal adenoma causing virilization of mother and infant

A right adrenal androgen-producing adenoma was identified by CT scanning in a 33-year-old woman after delivery of an otherwise-normal, virilized female infant. Despite clinical evidence of mild chronic androgen excess, maternal reproductive function was normal. Post-partum studies showed 2-5-fold excess in maternal plasma testosterone, androstenedione and dehydroepiandrosterone-sulphate; urinary androgen metabolites were increased 3-10-fold. Androgen production from the tumour increased acutely in response to hCG administration; after removal of the tumour, androgen levels were normal and showed negligible responses to hCG. These findings lead us to speculate that endogenous chorionic gonadotrophin may have led to augmented androgen production from the adrenal tumour during pregnancy, causing fetal virilization as previously described in patients with ovarian tumours. This study demonstrates that CT scanning can be valuable in distinguishing between adrenal and ovarian androgen-producing tumours, a distinction which is often unreliable when based on physiological manipulations of hormone secretion.