IDENTIFICATION OF VIRILIZING ADRENAL-TUMORS IN HIRSUTE WOMEN

Background. Hirsutism in women is usually caused by benign adrenal or ovarian disorders, but it can also be caused by adrenal carcinoma. The most effective way to identify such carcinomas is not known. Methods. We measured serum and urinary steroids before and after the administr ation of 3 mg of dexamethasone per day for five days in 14 hirsute wom en with histologically proved adrenal tumors (12 adrenal carcinomas an d 2 adrenal adenomas) and in 73 women with hirsutism of non-neoplastic origin. Results. All the women with adrenal tumors had elevated basal serum concentrations of testosterone or dehydroepiandrosterone sulfat e, as compared with 36 of the 73 women with non-neoplastic hirsutism ( sensitivity, 100 percent; 95 percent confidence interval, 77 to 100; s pecificity, 50 percent; 95 percent confidence interval, 38 to 62). Aft er the administration of dexamethasone, serum dehydroepiandrosterone s ulfate concentrations and urinary 17-ketosteroid excretion decreased t o values similar to those in normal women in all the women with non-ne oplastic hirsutism, but in none of the 12 with adrenal tumors who were tested. All the women who did not have adrenal tumors had serum corti sol concentrations below 3.3 mu g per deciliter (90 nmol per liter) af ter dexamethasone administration, whereas in all 12 patients tested wh o had tumors the values were higher. The suppression of serum dehydroe piandrosterone sulfate and cortisol and urinary 17-ketosteroid excreti on excluded the likelihood of adrenal tumors with a sensitivity of 100 percent (95 percent confidence interval, 74 to 100) and a specificity of 100 percent (95 percent confidence interval, 89 to 100). Conclusio ns. Among women with hirsutism, an adrenal tumor is unlikely it the pa tient has normal basal serum concentrations of testosterone and dehydr oepiandrosterone sulfate. In women in whom these concentrations are el evated, a tumor is unlikely if the serum concentration of dehydroepian drosterone sulfate and urinary 17-ketosteroid excretion are in the nor mal basal range and the serum cortisol concentration is less than 3.3 mu g per deciliter after the administration of dexamethasone.