{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:10:05Z","timestamp":1756314605536,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,12,17]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:p>Hirsutism is a common medical presentation to family physicians, internists and endocrinologists. Although the cause is commonly benign, a more serious or life-threatening one should not be missed. Here we report a 58-year-old woman, assessed for hirsutism and 15-pound weight gain, with associated easy bruising and mood swings. On physical examination, she was hypertensive with central obesity. Laboratory work was significant for erythrocytosis, leukocytosis with lymphopenia and transaminitis. With this initial clinical picture, a provisional diagnosis of cortisol and androgen hypersecretion was suspected. Further investigations revealed non-suppressible early morning cortisol after low-dose dexamethasone, elevated 24\u2009hours urinary-free cortisol and late night salivary cortisol. In addition, serum adrenocorticotropin hormone was low and androgens were elevated. These results supported the provisional diagnosis and imaging of the adrenals showed a large 10.4\u00d77.7\u00d75.2\u2009cm right adrenal mass, consistent with adrenocortical carcinoma, for which she underwent surgical resection.<\/jats:p>","DOI":"10.1136\/bcr-2019-232547","type":"journal-article","created":{"date-parts":[[2019,12,31]],"date-time":"2019-12-31T04:55:18Z","timestamp":1577768118000},"page":"e232547","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Adrenocortical carcinoma: an ominous cause of hirsutism"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2785-9398","authenticated-orcid":false,"given":"Suhaib","family":"Radi","sequence":"first","affiliation":[{"name":"Endocrinology and Metabolism, McGill University, Montreal, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Tamilia","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism, Sir Mortimer B Davis Jewish General Hospital, Montreal, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,12,30]]},"reference":[{"key":"2025082709412077000_12.12.e232547.1","first-page":"2565","article-title":"Evaluation and treatment of women with hirsutism","volume":"67","author":"Hunter","year":"2003","journal-title":"Am Fam Physician"},{"key":"2025082709412077000_12.12.e232547.2","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1210\/jc.2018-00241","article-title":"Evaluation and treatment of hirsutism in premenopausal women: an endocrine Society clinical practice guideline","volume":"103","author":"Martin","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"2025082709412077000_12.12.e232547.3","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-0990"},{"key":"2025082709412077000_12.12.e232547.4","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1097\/GME.0000000000000903","article-title":"Androgens in postmenopausal women: a review","volume":"24","author":"Shifren","year":"2017","journal-title":"Menopause"},{"key":"2025082709412077000_12.12.e232547.5","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1056\/NEJMra1505550","article-title":"Diagnosis and differential diagnosis of Cushing's syndrome","volume":"376","author":"Loriaux","year":"2017","journal-title":"N Engl J Med"},{"key":"2025082709412077000_12.12.e232547.6","first-page":"786","article-title":"Low DHEAS: a sensitive and specific test for the detection of subclinical hypercortisolism in adrenal incidentalomas","volume":"102","author":"Dennedy","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"key":"2025082709412077000_12.12.e232547.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12902-016-0095-9","article-title":"Adrenocortical cancer: mortality, hormone secretion, proliferation and urine steroids - experience from a single centre spanning three decades","volume":"16","author":"Calissendorff","year":"2016","journal-title":"BMC Endocr Disord"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-232547","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:41:28Z","timestamp":1756312888000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-232547"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":7,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2019,12,30]]},"published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1136\/bcr-2019-232547"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-232547","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,12]]}}}