Testosterone- and cortisol-secreting adrenocortical oncocytoma: an unusual cause of hirsutism

Abstract

Objective. Oncocytomas of the adrenal cortex are usually benign and nonfunctional. They are rarely seen as the cause of hirsutism. Therefore, we aimed to report a case of adrenocortical oncocytoma presenting with hirsutism. Methods. We report a testosterone- and cortisol-secreting adrenal oncocytoma in a 23-year-old female patient presenting with hirsutism. Results. The patient had the complaint of hirsutism for the last year. Laboratory tests revealed total testosterone level of 4.2 ng/mL, free testosterone of >100 pg/mL, and DHEAS level of 574 µg/dL. There was no suppression in cortisol levels with 2 mg dexamethasone suppression test (5.4 µg/dL). Adrenal MRI revealed a 27 × 25 mm isointense solid mass lesion in the left adrenal gland and the patient underwent laparoscopic left adrenalectomy. Pathological examination confirmed the diagnosis of benign adrenocortical oncoyctoma. Conclusion. This well-characterized case describes a testosterone- and cortisol-secreting adrenocortical oncocytoma as a possible cause of hirsutism. To our knowledge, this is the second report in the literature. Adrenal oncocytomas should always be considered in the differential diagnosis of hirsutism.

Figure 1

(a–c) Axial T1-weighted out-phase MR images (a), in-phase MR image (b), and three-dimensional GRE contrast-enhanced MR image show the intense mass in left adrenal gland. (c) shows no loss of signal intensity on the out-of-phase image.

Figure 2

Compressed adrenal cortical tissue is noted at the periphery. The tumor is a solid growth of neoplastic cells with eosinophilic cytoplasm (H&E × 40).

Figure 3

Immunohistochemical study showing diffuse positive staining for synaptophysin (immunohistochemistry, x100).