Ectopic Adrenal Rests in Congenital Adrenal Hyperplasia as a Cause of Androgen Excess After Adrenalectomy Detected by Pelvic Venous Sampling

In a case study of a female patient with classic congenital adrenal hyperplasia (CAH) who underwent bilateral adrenalectomy in early puberty due to poorly controlled CAH, it was found that several years post-surgery, she developed secondary amenorrhea and hair loss. These symptoms were attributed to androgen overproduction from ovarian adrenal rests, which were detectable only through pelvic venous sampling. Following a unilateral oophorectomy, her androgen levels normalized, suggesting that ectopic adrenal rests can cause androgen excess even after adrenalectomy and may require targeted surgical intervention.