Hyperandrogenism in a postmenopausal woman: a rare case of ectopic adrenal cortical gland

Abstract

Most frequent causes of androgenic manifestation are Cushing’s syndrome, PCO, benign and malignant androgen-secreting non adrenal tumors and iatrogenic hirsutism. Hyperplasia or neoplasms of ectopic adrenocortical gland are rare. We report a case of a 63-year old female with hirsutism and alopecia. Laboratory data highlighted increased levels of androgens. Diagnostic imaging revealed normal morphology of adrenocortical gland and ovaries. In view of the clinical picture and suspected diagnosis of extra-adrenal cause, she underwent bilateral salpingo-oophorectomy. Histologic examination showed an ectopic adrenal gland with adenoma in the ovarian and peri-ovarian tissue. At six months of follow up, the patients has no sign of hyperandrogenism. In case of hyperandrogenism in postmenopausal women and in the absence of the adrenocortical gland abnormality, ovarian origin should be considered in the differential diagnosis.

Chinese abstract

高雄激素表现的最常见原因是柯兴氏综合征、多囊卵巢、分泌雄激素的良性和恶性的非肾上腺肿瘤以及医源性多毛症。异位肾上腺皮质腺的增生或肿瘤是非常罕见的。我们报告的这一位有多毛症和脱发表现的63岁女性, 其实验室检查显示雄激素水平升高, 影像学检查显示肾上腺皮质腺和卵巢形态正常。鉴于临床图片和可疑肾上腺外因素的诊断, 我们对她进行了双侧输卵管+卵巢切除术。组织学检查显示在卵巢和卵巢周围组织中存在异位肾上腺的腺瘤。在6个月的随访中, 患者再也没有高雄激素血症的表现。绝经后女性高雄激素血症, 除外肾上腺皮质腺异常后, 在鉴别诊断中应考虑卵巢来源。

Keywords:

• Ectopic adrenal cortical gland
• hirsutism
• hyperandrogenism
• Leydig cell hyperplasia

Declaration of interest

The authors declare that they have no conflicts of interest regarding the publication of this article.