A 20-year-old female presents with increasing hair growth on her face and chest, deepening of her voice, and acne over the past year. She has no history of other medical problems. On examination, she has acne, abnormal male pattern balding, and enlargement of her clitoris. Blood tests show normal serum testosterone levels but a markedly elevated level of dihydroepiandrostenedione sulphate. What is the most likely diagnosis?
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Description: A- Pituitary tumor B- Adrenal tumor C- Ovarian tumor This young female has more than hirsutism, which is increased hair growth. She also has virilism, or the effects of androgens on the skin, voice, and clitoris. The hyperandrogenism seems to be of acute onset, which is consistent with an androgen-secreting tumor. The two possibilities include an ovarian tumor, usually Seoli-Leydig cell tumor, or an adrenal tumor. Because the pelvic examination and testosterone levels are normal, an ovarian etiology is less likely. Moreover, the high level of dihydroepiandrostenedione sulfate almost establishes the suprarenal (adrenal) gland as the cause. The next step would be a CT or MRI scan of the suprarenal glands to determine the exact location of the tumor. Usually surgery is indicated. Another cause of hirsutism is polycystic ovarian syndrome, which includes hirsutism, obesity, anovulation, and irregular menses. Cushing syndrome or disease presents strong coisol effects, such as buffalo hump, abdominal striae, easy bruising, and central obesity.
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