54-Year-Old Woman with Clitoromegaly

[摘要] A 54-year-old African American woman is referred for evaluation of clitoromegaly. Review of systems is normal. The patient is taking no medications, including exogenous steroids. She does not use alcohol, tobacco, or illicit drugs. Two of her sisters had thyroid goiters; family history otherwise is unremarkable. Physical examination demonstrates a body weight of 198 lb (90 kg), normal vital signs, and no abnormalities except an enlarged clitoris. Complete blood count; blood urea nitrogen, serum creatinine, glucose, and electrolyte levels; and urinalysis are normal. Serum testosterone level is 152 ng/dL (normal, 8–61 ng/dL in postmenopausal women). Serum calcium level is 10.8 mg/dL (normal, 8.5–10.5 ng/dL). Serum intact parathyroid hormone level is 135 pg/mL (normal, 12–72 pg/mL). Serum follicle-stimulating hormone, luteinizing hormone, and prolactin; plasma catecholamine; and adrenocorticotropic hormone levels are normal. Twenty-four-hour urinary excretion of free cortisol and ketosteroids is normal. Chest radiograph, pelvic and thyroid ultrasound studies, and magnetic resonance image (MRI) of the brain are normal. An uninfused computed tomography scan of the abdomen and pelvis demonstrates a 2 cm right adrenal mass with an attenuation coefficient of 5 Hounsfield units. Pertinent MRI images of the adrenal glands are shown in Figures 1 and ​and22.

[学科分类] 基础医学