A third case of a testosterone-secreting adrenal adenoma is presented. It differs from the other 2 cases in additionally having glucocorticoid abnormalities. Clinically, the patient had been considered as having polycystic ovaries and did show some improvement with estrogen therapy. In fact, were it not for enlarging uterine leiomyomata on this therapy which prompted a more in depth investigation to look for alternative therapy, this potentially malignant adrenal lesion may never have been discovered.

A very minimally hirsute anovulatory woman uho had failed to ovulate with 200 mg clomiphene citrate for five days had a successful ovulation and pregnancy with 150 mg clomiphene citrate plus glococorticoids for five days.A very minimally hirsute, anovulatory 27-year-old woman was treated with clomiphene citrate over several months without induction of ovulation or periods. Physical and pelvic examinations were normal; vaginal hormonal cytology suggested a possible androgen effect. Laboratory studies showed normal 17 ketosteroids. The patient was treated with prednisone, 5 mg before bedtime and 2.5 mg in the morning. After 1 month, 17 hydroxycorticosteroids were reduced from 4.8 to 2.2 mg, and 17 ketosteroids, from 11.2 to 6.7 mg. Serum testosterone decreased to a level of 32 ng/100 ml from 233 ng/100 ml. There was no ovulation with 10,000 units of human chorionic gonadotropin. Prednisone treatment was continued. After 5 days of medroxyprogesterone acetate (10 mg), clomiphene citrate (150 mg) was given for 5 days. A successful ovulation and pregnancy resulted. It is suggested that serum testosterone levels, vaginal hormonal cytology, and 17 ketosteroids should be performed routinely in anovulatory cases.