Education And Debate

Lesson of the Week: Adrenal mass with virilisation: importance of endocrine investigation

BMJ 1996; 313 doi: (Published 05 October 1996) Cite this as: BMJ 1996;313:872
  1. Joohi Nasir, research fellowa,
  2. Christopher Walton, consultant physiciana
  1. a The Michael White Diabetes and Endocrinology Centre, Royal Hull Hospitals, Hull HU3 2RW
  1. Correspondence to: Dr J Nasir, Department of Endocrinology, Addenbrooke's Hospital, Cambridge CB2 2QQ.
  • Accepted 11 July 1996

The combination of virilisation, increased androgen activity, and an adrenal mass on imaging in a female patient suggests a diagnosis of adrenal virilising tumour, for which appropriate treatment is surgical removal. Adrenal “incidentalomas,” however, are comparatively common, and this combination of problems can also be due to congenital adrenal hyperplasia. We describe a case of virilisation and left sided adrenal tumour in a 16 year old woman in whom a full endocrinological investigation would have avoided unnecessary surgery.

To prevent unnecessary surgery, all patients with adrenal masses should undergo a full endocrine evaluation irrespective of the apparent hormonal activity of the mass

Case report

A 16 year old woman was referred with primary amenorrhoea, poor breast development, hirsutism, acne, and excessive sweating. She had been investigated for being “above average height” at 8 years of age, for which no cause had been found, although details of investigations performed were not available.

Examination showed that she was 155 cm in height. Facial acne, greasy skin, generalised hirsutism and increased muscle bulk were noted. There was no breast development. Her blood pressure was 135/80 mm Hg. The findings on genital examination were not recorded. Chromosomal analysis confirmed a normal female karyotype (46XX), but testosterone and androstenedione concentrations were greatly …

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