A 58-year-old woman was virilized by a testosterone-secreting adrenal ganglioneuroma containing Leydig cells with crystalloids of Reinke. Examination of the ovaries revealed stromal hyperthecosis and hilus cell hyperplasia. The evidence from this case, as well as related cases in the literature, suggests that cells of the adrenal gland may become transformed into cells of gonadal type in both hyperplastic and neoplastic disorders.