Endocrine Abstracts

Hyperandrogenism and virilization are infrecuent in postmenopausal women and may result from androgen-producing tumors. Androgen-secreting adrenal tumors are rare in clinical practice and often diagnosed as adrenocortical carcinoma, while benign androgen-secreting adrenal tumors are even more rare.

Case presentation: A 63-year-old postmenopausal woman in follow-up for hypothyroidism reported hair loss, increased libido accompanied by deepening of the voice of more than 6 months of evolution. On physical examination she had a body mass index of 25 kg/m² and androgenic alopecia. There was no acne, hirsutism, clitoromegalia or other virilization signs. Findings on examination of the neck, breasts and abdomen were unremarkable. She had no signs of Cushing syndrome. Hormonal evaluation showed elevated serum androstenedione 3.2 ng/ml (reference value 0.3−2.7) and 17-hydroxyprogesterone 2.5 ng/ml (reference value 0.3−1 ). Nugent test, testosterone and dehydroepiandrosterone sulfate were within the normal range. Imaging examination showed nodule of 2 cm in diameter in the left adrenal gland with 13 Housfield units (HU) , wash out 98% and normal appearance of both ovaries. In addition the transvaginal gynecological ultrasound was normal. The patient develop low back pain and an adrenal CT scan was performed, showing adrenal nodule of 3 cm of 6 HU and wash out of 40% (indeterminate origin) Thus, adrenocortical carcinoma was suspected and then adrenalectomy was indicated. After two month and without surgery, she refered alleviated of manifestations of hyperandrogenism, additionally the level of androgens returned to normal range and the adrenal nodule was reduced to 2 cm (with 3.7 HU and wash out of 84%). A PET–CT with FDG confirmed a round nodule in the left adrenal gland and the SUV max of the nodule was 2, considering the possibility of benign adenoma and excluded ovarian abnormalities and other ectopic tumors. In the 3-year follow-up she was asymptomatic and the adrenal image remained unchange. In retrospect it was interpreted that she had a bleeding or necrosis in a virilizing adrenal adenoma that determined the clinical, biochemical and imaging changes.

Conclusion: The androgen source in women with hiperandrogenism and signs of virilism may be the ovary or adrenal gland. The elevated androstenedione and 17-hydroxyprogesterone indicated an adrenal origin. Despite being infrequent adrenal adenomas must be considered as a cause of hyperandrogenic syndrome.