Hirsutism is a common medical presentation to family physicians, internists and endocrinologists. Although the cause is commonly benign, a more serious or life-threatening one should not be missed. Here we report a 58-year-old woman, assessed for hirsutism and 15-pound weight gain, with associated easy bruising and mood swings. On physical examination, she was hypertensive with central obesity. Laboratory work was significant for erythrocytosis, leukocytosis with lymphopenia and transaminitis. With this initial clinical picture, a provisional diagnosis of cortisol and androgen hypersecretion was suspected. Further investigations revealed non-suppressible early morning cortisol after low-dose dexamethasone, elevated 24 hours urinary-free cortisol and late night salivary cortisol. In addition, serum adrenocorticotropin hormone was low and androgens were elevated. These results supported the provisional diagnosis and imaging of the adrenals showed a large 10.4×7.7×5.2 cm right adrenal mass, consistent with adrenocortical carcinoma, for which she underwent surgical resection.
- adrenal disorders
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Contributors SR collected data for case writing, did literature review and contributed to manuscript writing. MT contributed to manuscript writing and reviewed final manuscript before submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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