To the Editor.
—In a recent issue of JAMA, Kamilaris et al1 presented a case of a virilizing adrenal adenoma associated with an elevated testosterone level occurring in a 15-year-old girl. According to the authors, this represents the second youngest patient with a testosterone-secreting adrenocortical adenoma.We have reported elevated levels of testosterone in eight pediatric patients with virilizing adrenocortical tumors,2 and our review of the literature revealed several previous reports. Cacciari et al3 subsequently have reported nine similar cases. In fact, virilizing adrenocortical tumors in children are almost invariably associated with elevated testosterone levels, and measurement of this hormone may provide an important diagnostic and therapeutic marker. As noted by Kamilaris et al and others,4 urinary 17-ketosteroid levels, as measured by the Drekter method, are variable in this situation. We found elevated urinary 17-ketosteroid levels in all eight of our patients by using a modification