Endocrine Abstracts

Inroduction: Progressive baldness and severe hirsutism associated with granulosa cell tumor of ovaries are rare conditions in women. Reported cases are usually pubertal girls and young women. Here, we report a case of postmenopausal baldness and hirsutism due to granulosa cell tumor of the ovary.

Case report: A 62 year-old woman presented with baldness and hirsutism on her face, body and back for 3 years. She had menarche at 14 years and menopause at 52 years. She had regular menstrual periods until menopause. She had history of infertility which was refractory to treatment and impaired fasting glucose. Four years ago, she had undergone left oopherectomy due to an ovarian cyst which was benign in histological examination. On physical examination, Ferriman–Gallwey index was 24 with severe hirsutism on her face, body and back and male pattern baldness on her scalp. She was normotensive, her body mass index was 34 kg/m² and there was no cliteromegaly. Hormonal profile revealed elevated total testosterone, 5.31 ng/ml (0.06–0.82) and free testosterone, 18 pg/ml (0.29–3.18), low FSH 2.35 mIU/ml (25.8–134.8) and LH 3.45 mIU/ml (7.7–59) for postmenopausal women. Estradiol, prolactin, dehydroepiandrosterone sulphate, 17-hydroxyprogesterone, TSH and IGF1 levels were normal. She had 46, XX karyotype. Magnetic resonance imaging of abdomen and pelvis revealed a right ovarian mass. She underwent laparoscopically-assisted hysterectomy and right salpingo-oophorectomy. Microscopic examination of the right ovarian tumor revealed granulosa cell tumor. Three months after surgery, total and free testosterone levels decreased to 0.121 ng/ml and 0.68 pg/ml, respectively. FSH and LH rised to 25.76 and 21.31 mIU/ml, respectively. At 9 months, her testosterone levels were still low and hirsutism and baldness improved.

Conclusions: Although granulosa cell tumors are generally associated with manifestations of hyperestrogenism, our patient was in hyperandrogenemic and improved both clinically and biochemically after the operation.