Endocrine Abstracts

Introduction: Sertoli–Leydig cell tumours are rare tumours which account for <1% of all solid ovarian tumors. It mostly occurs in 2–4° decades of life. Rapidly progessing symptoms/signs of androgen excess suggest the presence of and androgen secreting tumor.

Case: Two postmenopausal patients (50 and 57 year-old) were referred to our Endocrinology Clinic for evaluation of worsening hirsutism. Both of patients had manifestations of hyperandrogenism symptoms such as increasing growth and coarseness of hair body and androgenic alopesia. They had no voice and weight changes, fatigue or galactorrhea. Their modified Ferriman–Gallwey score were 19 and 36. Laboratory studies revealed normal complete blood counts, liver and kidney tests. Both of them have had diabetes (for 2 and 3 years, respectively). Endocrinologic work-up revealed normal hormone levels except for increased levels of total and free testosterone. Pelvic ultrasonographic findings were normal in first patient and there was 1×1 right ovarian mass in USG in second patient. Magnetic resonance (MR) imaging of the abdomen and pelvis were performed, which demonstrated normal adrenal glands in both. The left ovary measured 2.6×1.9 cm in first patient and no enlargement or ovarian tumor was visualised in second patient. Positron emission tomography revealed increased metabolic activity in left ovary of first patient and was normal in second patient. Bilateral salpingo-oophorectomy were performed in both patients. Pathologic examination revealed 1.5 cm mass in the left ovary in first patient and 2.5 cm mass in the right ovary of second patient which were both diagnosed as Leydig cell tumor. After operation virilisation signs have almost completely disappeared and testesterone levels returned to normal in two patients.

Result: Diagnosing Leydig cell tumors can be challenging, even it is seen in younger age groups, it should not be dismissed in postmenopausal hyperandrogenism differential diagnosis.