Androgen-secreting tumour of the adrenal cortex without masculinization.

The patient, an unmarried woman of 22 years, presented with a history of irregular periods for four years. From the age of 19 she had developed scanty fine facial hairs, gained weight, and noticed a pronounced increase in her muscular power. Examination showed minimal hirsutism. The blood pressure was 140/80 mm Hg. There were no abdominal striae or palpable masses. Vaginal examination showed nothing abnormal and there was no clitoral hypertrophy. The haemoglobin was 18-0 g/100 ml and the P.C.V. 57°,'. The red cell mass was 32 ml/kg and the whole blood volume 61 ml/kg, indicating a moderate polycythaemia. Serum electrolytes and glucose tolerance were normal. Serum cholesterol was persistently low, 90-110 mg/100 ml. Intravenous pyelography showed the left kidney to be displaced downwards and a soft tissue shadow was visible over the upper pole. The 17-oxogenic steroid (17-OGS) and 17-oxosteroid (17-OS) outputs are shown in Table I. The 17-OS output was 10 times the normal value. Fractionated 17-OS steroids (Table II) showed that the major androgen appearing in the urine was dehydroepiandrosterone. The raised 11 oxy-17 oxosteroids suggested an adrenal origin. There was no suppression of 17-OS and 17-OGS with dexamethasone (Table III). The I.V.P. and endocrne investigations indicated the presence