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Adrenocortical tumors are rare in childhood and adolescence. Virilization, alone or in combination with signs of overproduction of other adrenal hormones, is the most common clinical presentation. Here we report an unusual case of an AfricanAmerican female adolescent presenting with idiopathic acquired generalized anhidrosis, dysregulation of body temperature, absence of adult body odor and dry skin in the face of a virilizing para-adrenocortical adenoma. Virilization signs regressed soon after removal of the tumor, but normalization of the 3 α -androstenediol glucuronide (3 α -AG) took longer compared to other measurable androgens; accompanied by anhidrosis. The association of remitting anhidrosis with normalized levels of 3 α -AG suggests it might be a possible mechanism for anhidrosis. High 3 α -AG levels might implicate the increased peripheral conversion of weak pro-androgens with different biochemical structure. We recommend obtaining 3 α -AG beside other androgens in virilized patients with atypical dermatological symptoms in the face of hyperandrogenism.

We describe a case of a ventriculoperitoneal shunt malfunction in which the tip of the peritoneal catheter found its way to the paraspinal subcutaneous tissues. The specific findings on physical examination and the results of the imaging made to make the diagnosis are presented. No prior report of migrating shunt tubing into this anatomic area was found in the literature. This curiosity is added to the list of organs or spaces shunts are capable of wandering into.