The evaluation of adult females with testosterone producing neoplasms of the adrenal cortex

Abstract

Although uncommon, testosterone producing neoplasms of the ovary and the adrenal cortex occur periodically. Forty-seven instances involving the adrenal gland have been published since 1925; five, including the present patient, have occurred since 1981. Confusion concerning the site of the androgen secretion has been generated in the past because of limited roentgenographic study and the poor predicability of selective suppression or stimulating testing of the adrenal gland and the ovary. Of the 22 patients with testosterone producing neoplasms of the adrenal cortex reported since 1973, 45 per cent underwent needless ovarian surgical treatment prior to the correct diagnosis. By recognizing the significant correlation between a serum testosterone of 200 nanograms per deciliter or greater, a serum dehydroepiandrostenone of greater than 6,600 nanograms per milliliter coupled with a thorough pelvic examination, pelvic ultrasound and a more liberal use of high resolution computerized tomography of the adrenal gland, the correct diagnosis can be made. The patient presented herein illustrates the pitfalls inherent in the management of a patient with this problem.