Endocrine Abstracts

Introduction: The severe course of hyperandrogenism during the menopausal transition requires the exclusion of androgen-secreting tumors.

Case report: A 60-year-old postmenopausal woman was referred to the Department of Endocrinology with a 3-year history of progressive development of hyperandrogenism with virilization (severe hirsutism, frontal balding, deepening of voice, increased muscle mass, and secondary polycythemia).

Hormonal evaluations revealed serum testosterone level in the male range (9.1–11.2 ng/ml), with decresed gonadotrophins and estradiol concentration characteristic of a follicular phase (107–117 pg/ml). Levels of androstenedione, DHEA-S, prolactin, cortisol, CA-125, and α-fetoprotein were normal.

Although initial imaging procedures (abdominal CT, pelvic MRI, and transvaginal ultrasound) failed to reveal the source of androgens synthesis, total hysterectomy and bilateral salpingo-oophorectomy was performed. Histopathological examination showed no pathological changes; however, testosterone level decreased significantly following the surgery (1.3 ng/ml) but did not achieve the female range (0.1–0.8 ng/ml). The patient showed significant regression of clinical signs and symptoms of hyperandrogenism, including the need of phlebotomy due to polycythemia.

Conclusions: The differential diagnosis of hyperandrogenism and virilization in postmenopausal women is challenging and requires well-considered clinical management due to the small size of ovarian androgen-secreting tumors.