VISUAL VIGNETTE

Physical exam demonstrated coarse terminal hair growth on her upper lip, chin (Fig. 1), posterior digits, and bilateral lower extremities. Initial laboratory results showed a total testosterone of 203 ng/dL (normal, 3 to 41 ng/dL), estradiol 26 pg/mL (normal, 5 to 138 pg/mL), follicle-stimulating hormone of 58 mIU/mL (normal, 25 to 134 mIU/mL), luteinizing hormone of 24 mIU/mL (normal, 7 to 58 mIU/mL), 17-hydroxyprogesterone of 25 ng/dL (normal, 15 to 70 ng/dL), and dehydroepiandrosterone sulfate 65.72 mcg/dL (normal, 19 to 205 mcg/dL). Tumors with estrogen excess have also been described to cause recurrence of menses in postmenopausal women.