MON-506 A Rare Case of Pure Androgen Secreting Adrenal Tumor in a Post-Menopausal Woman Found as an Incidentaloma on Imaging

Abstract Disclosure: O. Al Azzawi: None. A. Imran: None. F. Zhang: None. K.S. Kodroff: None. M. Bastidas: None. S.N. Subedi: None. Background: Pure androgen-secreting adrenal tumors are rare, and common symptoms include hirsutism and virilization syndrome. Presentation as an incidentaloma in an asymptomatic female poses a diagnostic challenge. Abstract: A 60-year-old female with a history of hypertension presented to the clinic after imaging revealed a right adrenal gland mass. She was asymptomatic, but examination showed she had chin hair for years. The lesion measured 5.2 x 3.6 cm on a CT scan, confirmed by MRI which showed a 5.2 cm x 3.6 cm right adrenal mass without significant loss of signal on the out-of-phase sequence of the opposed phases. Lab results showed elevated DHEA-Sulfate levels of 660 µg/dL (normal range: 29.4 - 220.5), confirmed at 792 µg/dL on a second test. Free testosterone was 13.7 pg/mL (normal range: 0.0 - 4.2 pg/mL) and total testosterone was 84 ng/dL (postmenopausal range: 7 - 40 ng/dL). Other hormones were normal: Cortisol AM was 1.70 µg/dL (normal range: AM: 6.7-22.6, PM: <10 µg/dL), Aldosterone was 7.1 ng/dL (normal range: 0.0 - 30.0 ng/dL), Normetanephrine (24-hour urine) was 435 µg/24 hr (normal range: 131 - 612 µg/24 hr), Metanephrine (24-hour urine) was 126 µg/24 hr (normal range: 36 - 209 µg/24 hr), Normetanephrine (plasma) was 160.8 pg/mL (normal range: 0.0 - 244.0 pg/mL), and Metanephrine (plasma) was 25.9 pg/mL (normal range: 0.0 - 88.0 pg/mL).Adrenalectomy was recommended, but she refused and opted for frequent imaging monitoring. She was prescribed spironolactone 25 mg daily for hirsutism. A repeated CT scan after 14 months showed a 5.3 x 3.5 cm homogeneous soft tissue right adrenal mass, unchanged in size. Differentiating between benign and malignant lesions without pathology was challenging. However, given the patient's long-standing hirsutism and the tumor's stable size, a benign lesion was suggested. Predicting adrenal malignancy is difficult but usually relates to tumor size, hormone type secreted, and tumor progression velocity. Diagnosis requires surgery and specimen pathology. Conclusion: Pure androgen-secreting adrenal tumors can sometimes be asymptomatic and present as incidentalomas. Workup should include hormonal hypersecretion checks in parallel with imaging for all lesions. If adrenal hormones are elevated, confirmation and surgery are necessary as definitive diagnosis still requires pathology. Presentation: Monday, July 14, 2025