Adrenocortical Tumor, Androgen Secreting

Occult

Step 1: View clinicals

A 23 year old woman presents with excessive growth of hair over her face, chest, and abdomen for 1 year. No other symptoms are present. Her medical, surgical, and family histories are unremarkable, while her menstrual cycles are regular, with menarche having taken place at the age of 12. A complete blood count, serum electrolyte assay, liver and renal profiles, and fasting plasma glucose are all within normal parameters.


Step 2: Order all relevant investigations

Early Morning Total Testosterone

Early Morning Total Testosterone: 440 ng/dL (8-60)

Endocrine Profile

Total Testosterone: 420 ng/dL (8-60) DHEAS: 620  microg/dL (35-430) Prolactin, TSH, FSH, LH, 17-OHP, Aldosterone: within normal parameters Urinary Free Cortisol: within normal parameters

CT Abdomen

There is a homogenous solid mass measuring 2.0 x 1.3 x 1.8 cm in the left adrenal gland, with regular margins. The attenuation of the mass is approximately 5 Hounsfield Units (HU). No other abnormalities are noted.

Percutaneous Fine Needle Aspiration Biopsy

The percutaneous fine needle aspiration biopsy reveals adrenal gland cells which are morphologically benign.


Step 3: Select appropriate management

Laparoscopic Adrenalectomy
Metformin
Glucocorticoids
Ketoconazole


Score: ★★☆