Testosterone-secreting gonadotropin-responsive adrenal adenoma and its treatment with the antiandrogen flutamide

A 55-year-old woman with virilization had an appreciably elevated testoster one level, which was not suppressed by dexamethasone, but was increased by stimulation with human chorionic gonadotropin (hCG). Ultrasonography and co mputed tomography revealed an adenoma 2.5-3.0 cm in diameter in the right a drenal gland. The patient was treated with the antiandrogen flutamide in a daily dose of 500 mg for 4 months. A substantial regression of her hirsutis m was observed during flutamide administration, but the serum testosterone level remained high. Right adrenalectomy was performed. Histologically, the tumor proved to be an adrenocortical adenoma of zona reticularis type. The adenoma tissue contained specific hCG receptors (1187 fmol/g). The steroid concentration in the tumor tissue was examined by means of high pressure l iquid chromatography-radioimmunoassay (HPLC-RIA). A significantly increased testosterone content was detected, and the levels of its precursors, andro stenedione and dehydroepiandrosterone, were also elevated. Following adrena lectomy, serum testosterone concentration decreased to the normal level. Th e mechanism of the inappropriate regulation in the testosterone production of the adrenal tumor has not been fully elucidated. (J. Endocrinol. Invest. 24: 622-627, 2001) (C) 2001, Editrice Kurtis.