Adrenal virilism is a syndrome in which excessive adrenal
androgens cause virilization. Diagnosis is clinical and
confirmed by elevated androgen levels with and without
dexamethasone suppression; determining the cause may involve
adrenal imaging. Treatment depends on the cause. Adrenal
virilism is caused by an androgen-secreting adrenal tumor or by
adrenal hyperplasia. Malignant adrenal tumors may secrete excess
androgens, cortisol, or mineralocorticoids (or all three),
resulting in Cushing syndrome (see Adrenal Disorders: Cushing
Syndrome) with suppression of ACTH secretion and atrophy of the
contralateral adrenal as well as hypertension. Adrenal
hyperplasia is usually congenital; delayed virilizing adrenal
hyperplasia is a variant of congenital adrenal hyperplasia (see
Endocrine Disorders in Children: Congenital Adrenal
Hyperplasia). Both are caused by a defect in hydroxylation of
cortisol precursors; cortisol precursors accumulate and are
shunted into the production of androgens. The defect is only
partial