Endocrine Abstracts

Background: Post menopausal hirsutism should raise suspicion of androgen secreting tumors. We present a case due to bilateral ovarian hyperthecosis with an adrenal incidentaloma.

Case history: 57 year old female patient was referred to us with history of new onset hirsutism over the past 2 years. She went through menopause 6 years back. On examination she had hirsutism affecting all her body, no evidence of virilization and no organomegaly on abdominal examination. Biochemical investigations revealed a testosterone level of 5.3 nmol/L (0.5–2.6). Dehydroepiandrosterone, androstenedione, ACTH, 17(OH) Progesterone levels were normal. MRI of adrenals and ovaries showed a 13 mm adenoma on the left adrenal gland with reduced washout after contrast and slightly enlarged bilateral ovaries. Overnight dexamethasone suppression test, renin/aldosterone ratio and urinary catecholamines were normal. Testosterone level did not suppress after dexamethasone. Bilateral adrenal vein and ovarian vein sampling ruled out the adrenal adenoma as the source of excess testosterone. She underwent bilateral oophorectomy; histology showed ovarian hyperthecosis on both sides. Post-operatively testosterone level (1.1 nmol/L) has normalised and hirsutism improved.

Conclusion: Post menopausal hirsutism is rare and mostly caused by benign conditions. It is important to rule out androgen secreting ovarian and adrenal tumours. Ovarian hyperthecosis is a less well known cause of this condition. In our case presence of a left adrenal incidentaloma posed an additional diagnostic challenge. Bilateral adrenal and ovarian vein sampling was essential to determine the source of high testosterone leading to appropriate management.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.