Testosterone-Secreting Adrenal Adenoma under Gonadotropin Control

Abstract

A 51-year-old woman with virilization had markedly elevated levels of testosterone, which increased further following stimulation with human chorionic gonadotropin. Urinary excretion of 17-ketosteroids was normal or slightly elevated. After removal of both ovaries, which showed only mild strumal hyperplasia, testosterone levels and responsiveness to human chorionic gonadotropin remained unchanged. Administration of conjugated estrogens suppressed testosterone and gonadotropin levels. Subsequently, a small adrenal adenoma was removed, and androgen levels returned to normal. The androgens in the adenoma were mainly testosterone. Thus, this patient had the unusual occurrence of a small adrenal adenoma that produced testosterone and was responsive to gonadotropin. (N Engl J Med 289:767–770, 1973)