Pure Androgen-Secreting Adrenal Adenoma Associated with Resistant Hypertension

Pure androgen-secreting adrenal adenoma is very rare, and its diagnosis remains a clinical challenge. Its association with resistant hypertension is uncommon and not well understood. We present an 18-year-old female with a 10-year history of hirsutism that was accidentally diagnosed with an adrenal mass during the evaluation of a hypertensive crisis. She had a long-standing history of hirsutism, clitorimegaly, deepening of the voice, and primary amenorrhea. She was phenotypically and socially a male. FSH, LH, prolactin, estradiol, 17-hydroxyprogesterone, and progesterone were normal. Total testosterone and DHEA-S were elevated. Cushing syndrome, primary aldosteronism, pheochromocytoma, and nonclassic congenital adrenal hyperplasia were ruled out. She underwent adrenalectomy and pathology reported an adenoma. At 2-month followup, hirsutism and virilizing symptoms clearly improved and blood pressure normalized without antihypertensive medications, current literature of this unusual illness and it association with hypertension is presented and discussed. 1. Introduction Benign and malignant tumors of the adrenal gland might be functional or silent. The majority of these tumors are benign, nonfunctioning adenomas that are incidentally discovered on abdominal image studies. Others are functional adenomas able to secrete cortisol, aldosterone, or less commonly androgens or estrogens [1]. Pure androgen-secreting adrenal tumors are very unusual, and their diagnosis represents a clinical challenge. Hirsutism and virilization syndrome, characterized by clitorimegaly, male pattern baldness, and deepening of the voice along with menstrual irregularities are the most common findings [2–4]. Resistant hypertension is also a clinical feature in these cases, and it is defined as arterial hypertension above goals in spite of the concurrent use of three different antihypertensive drugs of different classes, including a diuretic [5]. The association of pure androgen-secreting adrenal tumors with hypertension has exceptionally been reported. Most of the cases have been carcinomas and mixed hormone-secreting tumors [6–8]. Even though it is well known that testosterone can increase blood pressure and epidemiological studies have demonstrated a higher blood pressure in males than females, most studies agree that androgens are only an aggravating factor rather than the exclusive cause of resistant hypertension [9, 10]. Herein, we present the case of an 18-year-old female with a 10-year history of hirsutism, virilization, and primary amenorrhea associated to an incidental