Endocrine Abstracts

A 55-year-old female presented to her General Practitioner with hirsutism, male pattern baldness, weight gain and a deepening of voice. Her past medical history included well controlled type 2 diabetes on gliclazide, and hysterectomy for menorrhagia. She had an elevated serum testosterone after solvent extraction (18 nmol/l) and free androgen index (17.6). The patient was referred for further investigation.

17-Hydroxyprogesterone and dehydroepiandrosterone-sulphate were within reference intervals. Androstenedione was slightly elevated. Urinary cortisol was not elevated and suppressed following dexamethasone, however testosterone remained elevated. Abdominal CT scan revealed a lesion above the right adrenal bed which was suspicious of malignancy. The scan also suggested a bulky left ovary, however trans-vaginal ultrasound was unremarkable. Catecholamines and CA-125 were normal.

She underwent laparoscopic resection of her right-sided abdominal mass, histopathology of which was reported as an insulinoma. Post-operatively she required insulin to control her diabetes, possibly following the reduction in insulin secretion.

Her testosterone fell immediately to 1.2 nmol/l, however later climbed again to 12.8 nmol/l. She received a trial dose of a gonadotrophin-releasing hormone analogue and the serum testosterone concentration fell to 0.6 nmol/l. This indicated an ovarian source for the excess androgens. She then underwent bilateral salpingo-oopherectomy. Pathology revealed marked stromal hyperplasia in both ovaries which was likely to be the cause of her hyperandrogenism.