Alopecia with male-pattern androgenetic alopecia linked to an adrenal tumor: a case report

Androgenetic alopecia (AGA) is a type of hair loss that often manifests as male or female pattern baldness. In women, androgenetic alopecia resembling male-pattern baldness can occur in conditions of hyperandrogenism, such as congenital adrenal hyperplasia or ovarian and adrenal tumors, which are exceedingly rare, occurring in approximately 0.2% of cases. We report a 62-year-old female exhibiting hair loss and hirsutism that began over a decade ago. The medical examination reveals hirsutism on the face, abdomen, and chest, and hair loss in the fronto-parieto-occipital region, with a male pattern distribution consistent with grade VII on the Hamilton scale. Trichoscopy revealed loss of follicular openings, single follicular units, miniaturized hairs, and perifollicular brown halo. Laboratory tests indicated a total testosterone level of 10.15 ng/ml. An abdominal CT scan revealed bilateral adrenal adenomas, which were subsequently treated with laparoscopic radical adrenalectomy. In postmenopausal women, a new-onset state of hyperandrogenism may lead to virilizing symptoms, such as male-pattern alopecia, when testosterone levels exceed 5 nmol/L, necessitates immediate investigation to exclude an androgen-producing tumor, which typically normalizes swiftly within weeks post-surgery, while symptoms of androgen excess gradually diminish following the normalization of testosterone levels, as observed in our case.