{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:03:26Z","timestamp":1784783006745,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Virilization in girls younger than 2 years should prompt careful evaluation for pathological androgen excess and should be interpreted as a practical clinical reminder rather than as a stand-alone diagnostic tool. Pediatric adrenocortical tumors (ACTs) are rare but are usually hormonally active, and their interpretation requires pediatric-specific clinicopathological criteria rather than direct application of adult adrenal carcinoma criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 19-month-old girl presented with a 6-month history of progressive voice deepening, pubic hair growth, and clitoromegaly. Beard-like facial hair, acne, axillary hair, adult-type body odor, and vaginal bleeding were not reported. Basal gonadotropins were suppressed, gonadotropin-releasing hormone analogue stimulation showed a non-pubertal luteinizing hormone response, bone age was advanced, and dehydroepiandrosterone sulfate was markedly elevated (&amp;gt;1,000 \u03bcg\/dL; above the assay upper reportable limit). Imaging identified an approximately 5-cm right adrenal mass. The patient underwent open surgical resection. Histopathology showed an ACT of uncertain malignant potential with a formally reported Wieneke score of 3, based on increased or borderline-high mitotic activity as interpreted in the pathology report, atypical mitotic figures, and capsular invasion. Immunohistochemistry showed steroidogenic marker expression, a missense-mutant p53 pattern, focal reticulin rarefaction, and a Ki-67 hotspot index of approximately 30%. Postoperative androgen levels declined markedly, and biochemical remission was maintained at 4 and 8 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Androgen-dominant virilization preceded and outweighed mild breast development, serving as a practical reminder to prioritize adrenal-focused assessment in very young girls with rapidly progressive virilization. Preoperative ultrasonography, contrast-enhanced computed tomography, and magnetic resonance imaging were performed; dedicated postoperative contrast-enhanced abdominal CT or MRI had not yet been obtained during the available follow-up period. Genetic testing was incomplete because the family declined germline testing after counseling; testing of the proband should be re-offered during follow-up, with cascade testing for first-degree relatives if a pathogenic germline variant is identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Long-term surveillance should include endocrine assessment, pubertal monitoring, genetics re-counseling, and protocolized cross-sectional imaging, because early biochemical remission does not exclude recurrence or later secondary central precocious puberty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1899515","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:33:56Z","timestamp":1784781236000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case 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