Thanks for the 4 colleagues who responded so far, exhibiting various valid points as follows:

1. Try putting “testosterone-secreting ovarian tumor”into Google Scholar.

2. Was ‘she’ hypertensive?  I am puzzled. Looks like a girl brought up as a boy.

How about 17hydroxlase deficiency?

Steroid profiling would be the next step and of course karyotyping.

3. I wonder if this is a case of 5 alpha reductase deficiency if not ?on progestorone pills.

4. Measure DHT? alpha reducatse activity ?Androgen insensitivity? Taken testo injection? iatrogenic? Other androgens - dheas, a4, 17oh prog , ovarian/liver scans?

Gender assignment? Androgen secreting tumour?

Further info and final diagnosis:

Karyotyping: 46XX
Not taking any exogenous testosterone.
Examination reveals signs of hirsuitism that the patient conceals well as she works in a beauty saloon. She also has a deep voice that she tries to conceal.

Further tests showed:

DHEAS H >27.1 umol/L (0.0-12.0)
Androstenedione H >35.0 nmol/L(3.0-10.0)
17-OH-Progesterone 9.7 nmol/L (< 12)
Cortisol 243 nmol/L

MRI of adrenal showed a well encapsulated 5 cm lesion in the right adrenal.

This is likely to be a benign androgen secreting adrenal adenoma, and patient should be cured by its removal.

The very high testosterone is a bit unusual for an adrenal adenoma, even when using extraction step, the testosterone level was quite high at 18.5 nmol/L. The direct assay probably showed a lot of interference from DHEAS and androstenedione. However, the patient has done well to conceal her virilsation features. I also found it unusual to come across two aetiologically different cases of females with male level tsetsosterone in such a short period of time. It all adds up to our continuous learning, I hope.

regards

Mohammad