Endocrine Abstracts

Objective: To report a case of hyperandrogenism attributable to the presence of an ovarian Leydig cell tumor secreting testosterone in a postmenopausal woman.

Methods: The laboratory, radiologic, and pathologic findings in our case are described.

Results: A 59-year-old woman presented with a history of gradual increase in facial and body hair, scalp hair loss, male pattern baldness, and deepening of her voice, beginning 5–6 years before. She had two normal pregnancies and spontaneous menopause at age 47 years. She had hypertension and hyperlipemia. Laboratory tests showed elevated levels of total testosterone (575 ng/dl), very low gonadotrophin levels and normal levels of 17-OH-Pg, Androstendione and DHEA-S. Her high level of testosterone was not suppressed with dexamethasone. Ultrasound study and abdominal computed tomographic scan showed the adrenal glands to be normal in size. Transvaginal ultrasonography revealed no tumor. Bilateral oophorectomy was performed, and an ovarian Leydig cell tumor in left ovary was diagnosed, in the contralateral ovary a stromal hyperplasia was found (non-neoplastic condition of the ovary also associated with clinical manifestations of hyperandrogenism from ovarian production of male hormones). The postoperative serum testosterone level returned to normal and the patient showed a slow regression of clinical symptoms after the surgical intervention.

Conclusion: Our case illustrates that a virilizing ovarian tumor can be small and elude imaging studies, but may be detected by means of well-considered clinical management. And, particularly in our case, we found a Leydig cell tumor and a contralateral stromal hyperplasia.