VIRILIZING ADRENOCORTICAL TUMORS IN ADULT WOMEN - REPORT OF 10 PATIENTS, 2 OF WHOM EACH HAD A TUMOR SECRETING ONLY TESTOSTERONE

Background. Virilizing adrenocortical tumors are uncommon in adult wom en. These lesions generally secrete dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS), but not testosterone, which us ually is produced by ovarian tumors. Exceptionally, adrenal growths ma y give off testosterone and no other assessable androgen. The detectio n of the site of excess testosterone yield is paramount for proper sur gery. The true nature of the growth often is unpredictable, even at th e time the pathologist examines the surgical specimen. Methods. The wo rkup in a virilized adult woman relies on biochemical tests such as 24 -hour urinary 17-KS and 17-OHCS levels and plasma corticosteroid level s (testosterone, DHEA, DHEAS, and androstenedione), and on modern imag ing studies such as ultrasonography, computed tomography, and digital angiography. Results. Among a series of 190 adrenal tumors collected i n the last 30-year period, only 10 virilizing growths (5.3%) were dete cted. Two cases of virilization mixed with cushingoid features were ob served. In two other cases, reported in detail, the tumor secreted tes tosterone only, without other assessable androgens. Seven of the 10 tu mors were malignant. Conclusions. In cases of tumors secreting testost erone only, high-resolution imaging has contributed significantly in p inpointing the site of the growth, whereas dynamic hormone testing, us ing selective stimulation or suppression studies, has been misleading. The malignant nature of the growth may be revealed only by the presen ce of metastases, because pleomorphism and capsular and vascular invas ion have been detected histologically in clinically benign tumors. The prognosis for large tumors usually is dismal.