Abstract

Background: Androgen-secreting adrenal tumors are a rare cause of hirsutism, accounting for less than 0.2% of cases. Most large androgen-secreting adrenal masses are malignant adrenocortical carcinomas. We report a case of an unusually large benign adrenal adenoma simultaneously secreting cortisol and androgens.
Case presentation: A 32-year-old woman presented with a one-year history of menstrual irregularities, hair loss, hirsutism, and acne. Laboratory findings revealed elevated testosterone (175ng/dL), free testosterone (7.22pg/mL), DHEA-S (1000μg/dL), and cortisol levels with failure to suppress on the dexamethasone suppression test. Magnetic resonance imaging demonstrated an 8.5 cm left adrenal mass with imaging characteristics initially concerning for malignancy. Laparoscopic adrenalectomy was performed, and histopathological examination revealed a benign adrenocortical adenoma with a weiss score of 0. The patient experienced complete resolution of symptoms postoperatively.
Conclusions: This case demonstrates that large benign adrenal adenomas can rarely present with dual hormone secretion and significant virilization symptoms. While size and hormone profile may suggest malignancy, histopathological examination remains the definitive diagnostic method. Complete surgical resection provides excellent outcomes for functional adrenal adenomas.

Keywords:Adrenal adenoma; Hirsutism; Androgen excess; Cortisol; Virilization; Weiss score