title: Coincidental diagnosis of an occult hilar steroid cell tumor of the ovary and a cortisol-secreting adrenal adenoma in a 49-year-old woman with severe hyperandrogenism.
abstract: OBJECTIVE
  To report an exceptional association between an occult ovarian steroid cell tumor and a cortisol-secreting adrenal adenoma.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Endocrinology and nutrition unit at a general hospital in Spain.
  
  
  METHODS
  A 49-year-old woman who presented with persistence of severe hyperandrogenism after removal of a left adrenal adenoma.
  
  
  METHODS
  An endocrine study evaluating serum androgens, adrenal function, and tumor markers was ordered. Transvaginal sonography was done to rule out an ovarian tumor. Finally, a selective catheterization of ovarian veins allowed the correct diagnosis.
  
  
  METHODS
  Clinical and endocrine description of the patient and preoperative localization of the source of T secretion.
  
  
  RESULTS
  After adrenal surgery, urinary free cortisol levels decreased to normal values, but serum T remained within the tumoral range (3.04 ng/mL). Selective catheterization of ovarian veins revealed a gradient of T concentration in the right ovary. After bilateral annexectomy, a microscopic steroid cell tumor of hilar type was found in the right ovary. Serum T fell within the normal range, and hirsutism progressively improved.
  
  
  CONCLUSIONS
  This unusual association between an occult-virilizing ovarian steroid cell tumor and a cortisol-secreting adrenal adenoma illustrates the value of an accurate preoperative workup in women with severe hyperandrogenism.
authors.affiliation: Unit of Endocrinology and Nutrition, Fundación Hospital of Alcorcón, Madrid, Spain. jjgorgojo@fhalcorcon.es
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Gorgojo
authors.forename: Francisca
authors.initials: F
authors.lastname: Almodóvar
authors.forename: Elena
authors.initials: E
authors.lastname: López
authors.forename: Julian
authors.initials: J
authors.lastname: Vicente del Cerro
authors.forename: Eva
authors.initials: E
authors.lastname: Tejerina
authors.forename: Sergio
authors.initials: S
authors.lastname: Donnay
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D000315:Adrenalectomy; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D006628:Hirsutism / Q000209:etiology*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D017588:Hyperandrogenism / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D010051:Ovarian Neoplasms / Q000175:diagnosis*; D016896:Treatment Outcome
chemical_list: D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone