Hyperandrogenism due to a testosterone-secreting Sertoli-Leydig cell tumor associated with a dehydroepiandrosterone sulfate-secreting adrenal adenoma in a postmenopausal woman: case presentation and review of literature.
OBJECTIVE
To report a case of hyperandrogenism attributable to the presence of an adrenal adenoma secreting dehydroepiandrosterone sulfate (DHEA-S) and an ovarian Sertoli-Leydig cell tumor secreting testosterone in a postmenopausal woman.


METHODS
The laboratory, radiologic, and pathologic findings in our case are described. In addition, the pertinent literature is reviewed.


RESULTS
A 56-year-old woman presented with a history of gradual increase in facial and body hair, scalp hair loss, male pattern baldness, and deepening of her voice, beginning a few years after spontaneous menopause at age 49 years. She had hypertension, obesity, and type 2 diabetes mellitus. Laboratory tests showed elevated levels of total testosterone (348 ng/dL) and DHEA-S (2,058 microg/dL), and a left adrenal tumor (3 by 4 cm) was detected on abdominal computed tomographic scan. Laparoscopic left adrenalectomy was performed, and the pathologic diagnosis was adrenal adenoma. The DHEA-S returned to normal levels, but the serum testosterone concentration remained elevated. Transvaginal ultrasonography disclosed an ovarian tumor. Bilateral oophorectomy was performed, and an ovarian Sertoli-Leydig cell tumor was diagnosed. The hormonal and clinical picture normalized after this surgical intervention.


CONCLUSIONS
After extensive review of the literature, we believe that this is the first reported case of a coincidental DHEA-S-secreting adrenal adenoma and a testosterone- secreting ovarian Leydig cell tumor causing signs of virilization.
Herrera
Jorge D
JD
Section of Endocrinology and Diabetes, Hospital Dr Guillermo Rawson, School of Medicine, Catholic University of Cuyo, San Juan, Argentina.
Davidson
Jaime A
JA
Mestman
Jorge H
JH
D018246:Adrenocortical Adenoma / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D000505:Alopecia; D019314:Dehydroepiandrosterone Sulfate / Q000378:metabolism*; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D007984:Leydig Cell Tumor / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D008875:Middle Aged; D017698:Postmenopause; D013739:Testosterone / Q000378:metabolism*
D013739:Testosterone; D019314:Dehydroepiandrosterone Sulfate