Virilisation in a Young Woman: A Case Demonstrating the Importance of Co-Located Mental and Primary Healthcare

In 2019, a 22-year-old woman presented with symptoms of anxiety, amotivation, and low mood, along with marked hirsutism. She had a regular menstrual cycle and no family history of diabetes or heart disease. She had been vegan for 12 months and had lost 10 kg in the past year. She had no abdominal pain, gastrointestinal or genitourinary symptoms. Upon examination, the GP noted signs of virilisation, including marked coarse, dark, male distribution hair pattern on various parts of her body, androgenic alopecia, laryngeal enlargement with deepened voice, and muscle hypertrophy. Various tests were conducted, and the results suggested Polycystic Ovary Syndrome (PCOS) secondary to virilisation. However, high testosterone levels indicated an androgen-secreting adrenal neoplasm. The patient underwent successful laparoscopic right adrenalectomy, and her androgen levels reduced dramatically post-surgery. Eight months post-surgery, her testosterone and androstenedione levels were normal, and her physical symptoms of virilisation had decreased. Her anxiety subsided, drug use ceased, and she returned to her studies. The case highlighted the importance of timely investigation in females with secondary virilisation and the association between emotional wellbeing and physical health.