Endocrine Abstracts

Objective: To describe a postmenopausal lady with hirsutism secondary to a rare leydig cell tumour of the ovary.

Case history: A 55 year lady who attained menopause at the age of 49 was referred to us by GP for facial hirsutism of 5 years duration. She was bothered by recent excess hair growth of 4 months duration on the face and arms. She had no other virilising symptoms.

On examination, she appeared cushingoid, had a BMI of 31, had excess hair growth over the face and arms but did not show signs of easy bruising, purple striae and proximal myopathy.

She had high hemoglobin of 18.4 g%. Basal serum testosterone levels done on two occasions were high at 13.6 and 19 nmol/l respectively. Luteinising and follicule stimulating hormone values were in the postmenopausal range. Twenty-four hour urines for free cortisol excretion done on two successive days were within the normal range. She had normal baseline concentrations of dehydroepiandrosterone sulfate and androstenedione. Computed tomographic (CT) scans of the adrenals and ultrasonography of the pelvis were negative. Subsequently she had total abdominal hysterectomy with bilateral salphingo-oopherectomy. Right ovary revealed an ovarian fibroma along with a second lesion suggestive of leydig cell tumour on histologic examination. Postoperatively testosterone and hemoglobin values returned to normal.

Conclusion: Our case illustrates that there can be a lag between the onset of symptoms and presentation to the physician. Total abdominal hysterectomy with bilateral salphingo-oophorectomy might be a reasonable approach of treatment in postmenopausal women with recent onset of worsening of hirsutism and without Cushing’s syndrome with normal adrenal imaging. This approach avoids unnecessary investigations.