An unusual case of bilateral virilizing adrenal adenoma co-secreting androgens and cortisol

We report the case of a 68-year-old woman presenting with clinical and biochemical evidence of hyperandrogenism. Imaging studies revealed the presence of a bilateral adrenal tumor. Although there was a predominant secretion of androgens, autonomous production of cortisol was also evidenced on the basis of an inversion of the circadian rhythm of plasma cortisol and an absence of cortisol suppression by dexamethasone. The functional status of both tumors was demonstrated by an iodocholesterol scintigraphy and by an adrenal vein catheterization. Surgical excision of both adrenal tumors was performed and histological examination disclosed no criteria of malignancy. The patient still remains disease-free 3 years after surgery. To our knowledge, this is the second report of the bilateral occurrence of a virilizing adrenal tumor and the first in which the functional characteristics of the tumors are detailed.