Mild Cutaneous Manifestation in Two Young Women with Extraordinary Hyperandrogenemia

In the 2005 study, two young women with primary amenorrhea exhibited unusually high levels of androgens but only mild skin symptoms. The first patient, with vertical alopecia, had a serum dehydroepiandrosterone sulfate level greater than 800 µg/dl, suggesting late-onset, non-classical adrenal hyperplasia. The second patient, with mild acne, had an extremely high serum total testosterone level over 9,000 ng/dl, which was linked to an androgen-secreting adrenal adenoma that overexpressed several steroidogenic enzymes. These cases underscore the importance of thorough history-taking and physical examinations in females with acne or alopecia, and they highlight the need to consider the possibility of an adrenal tumor in patients with significantly elevated testosterone levels.