Adrenal virilism is a syndrome in which excessive adrenal androgens cause virilization. Diagnosis is clinical and confirmed by elevated androgen levels; determining the cause may involve adrenal imaging.
Adrenal virilism is caused by
Androgen-secreting adrenal tumors
Malignant adrenal tumors may secrete excess androgens, estrogens, cortisol, mineralocorticoids. If there is cortisol hypersecretion, Cushing syndrome results, with suppression of adrenocorticotropic hormone (ACTH) secretion and atrophy of the contralateral adrenal as well as hypertension.
It general effects depend on the patient’s sex and age; it effects more in women than men.
Female infants with congenital adrenal hyperplasia may have fusion of the labioscrotal folds and clitoral hypertrophy resembling male external genitalia, thus presenting as a disorder of sexual differentiation.
In prepubertal children, growth may accelerate. If untreated, premature epiphyseal closure and short stature in adulthood occur. Affected prepubertal males may experience premature sexual maturation.
Adult females may have amenorrhea, atrophy of the uterus, clitoral hypertrophy, decreased breast size, acne, hirsutism, deepening of the voice, baldness, increased libido, and increased muscularity.
Adrenal virilism is suspected clinically, although mild hirsutism and virilization with hypomenorrhea and elevated plasma testosterone may also occur in polycystic ovary syndrome (Stein-Leventhal syndrome). Adrenal virilism is confirmed by showing elevated levels of adrenal androgens.