Background: Virilization or masculinization is the biological development of adult male characteristics in females. Most of these changes are produced by androgens. Virilization could be associated with either benign or malignant conditions of the ovaries or the adrenal glands. The most common pathology to cause secondary amenorrhea in a woman of reproductive age-group is polycystic ovarian syndrome. Another important differential, especially in women with severe virilization, is androgen-secreting tumors. Case description: This case report is about a 30-year-old female with secondary amenorrhea for 8 years with features of severe virilization. She was found to have an androgen-secreting right adrenal mass and underwent a successful open adrenalectomy. The histopathology revealed an oncocytic variant of adrenocortical cancer. Conclusion: Secondary amenorrhea is also a very common condition seen in women of reproductive age-group, however, when accompanied by severe virilization, it must raise suspicion for the evaluation of other pathologies such as adrenal tumors as adrenocortical carcinoma (ACC) can be life-threatening if not treated at an early stage. Clinical significance: This case report shows the importance of identifying features of virilization in cases of secondary amenorrhea. It describes the hormonal workup of such patients and its management. It also discusses the controversies regarding the adjuvant treatment of adrenocortical cancer and the need to individualize treatment based on resource constraints.