Adrenal Cortical Tumor Causing Hirsutism Without Other Evidence of Virilization

A well developed 28-year-old brunette female came to the Endocrine Clinic in 1947, complaining of an extreme degree of hirsutism of fourteen years' duration. The patient's ancestry was Indian, French and Spanish. Excessive hair on the face and abdomen was first noticed at the age of 12 years, and had increased since that time. On initial examination she was found to have profuse heterosexual hypertrichosis, the beard, axillary, pubic, and body hair being much more extensive than in the average male. In addition to the hirsutism, she also displayed a degree of muscular development which was considerably more than average. The patient's voice was feminine; her breasts were well developed; the clitoris was normal; and menstruation, which began at the age of 12 years, had always been regular. She had had one pregnancy with a spontaneous miscarriage at five months. She also stated that her libido was somewhat more than adequate. She was first seen in the Endocrine Clinic by Dr. L. E. Curtis, who ordered a 17-ketosteroid determination and an intravenous pyelogram. The initial 17-ketosteroid values were 82 and 62 mg. respectively (ketonic fraction) per twenty-four hours. The beta 17-ketosteroids constituted 55 per cent of the total.1