Occult

A 23 year old woman presents with excessive growth of hair over her face, chest, and abdomen for 1 year. No other symptoms are present.

Her medical, surgical, and family histories are unremarkable, while her menstrual cycles are regular, with menarche having taken place at the age of 12.

A complete blood count, serum electrolyte assay, liver and renal profiles, and fasting plasma glucose are all within normal parameters.

Select Relevant Investigations
Early Morning Total Testosterone

Performed

Early Morning Total Testosterone: 440 ng/dL (8-60)
Endocrine Profile

Performed

Total Testosterone: 420 ng/dL (8-60)
DHEAS: 620  microg/dL (35-430)
Prolactin, TSH, FSH, LH, 17-OHP, Aldosterone: within normal parameters
Urinary Free Cortisol: within normal parameters
CT Abdomen

Performed

There is a homogenous solid mass measuring 2.0 x 1.3 x 1.8 cm in the left adrenal gland, with regular margins. The attenuation of the mass is approximately 5 Hounsfield Units (HU). No other abnormalities are noted.
Percutaneous Fine Needle Aspiration Biopsy

Performed

The percutaneous fine needle aspiration biopsy reveals adrenal gland cells which are morphologically benign.

Select Relevant Management
Laparoscopic Adrenalectomy
Metformin
Glucocorticoids
Ketoconazole