Hyperandrogenism with hyperandrogenemia should be considered in those with sev ere acne of sudden onset or conspicuous male-pattern baldness with hairline rec ession, although the majority of female patients with acne or androgenetic alope cia possess no endocrine diorder. Herein we describe on the contrary 2 young wom en with primary amenorrhea displaying prominent hyperandrogenemia but subtle cut aneous manifestation. The first one presenting vertical alopecia had an elevated level of serum dehydroepiandrosterone sulfate (>800 μg/dl)and was suspected to be a case of late-onset, non-classical adrenal hyperplasia. The second case w ith mild acne had a soaring serum level of total testosterone >9,000 ng/dl deriv ed from an androgen-secreting adrenal adenoma overexpressing steroidogenic acut e regulatory protein, P450 side-chain cleavage enzyme and aromatase. A careful patient history and a complete physical examination are mandatory in each indivi dual female case with acne or alopecia. The possibility of adrenal tumor should be explored in patients with escalated circulating testosterone.
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