Endocrine Abstracts

Introduction: Androgen excess in women usually is presented as hirsutism and alopecia. Androgens could be expressed from adrenal or ovarian origin.

Case reports: Female, 57 years (yrs) old, presented with hirsutism (Ferriman Galwey score, FGS 18), weight gain, type 2 diabetes mellitus (DM2), hypertension, hyperlipidemia and obesity (BMI 38.5 kg/m²). Diagnostic evaluation revealed normal prolactin, SHBG, DHEAS, IGF-1, ACTH, TSH, serum cortisol in overnight 1 mg dexamethasone test (19 nmol/l); total testosterone (6.0 nmol/l; ref.<2.6), free testosterone (94.8 pmol/l; ref.<30) and androstendion (14.1 umol/l; ref.<12) were increased. MRI of abdomen and pelvis showed fatty liver and myoma uteri. Bilateral ovariectomy was performed; PHD: hyperthecosis. Signs of hyperandrogenism regressed.

Postmenopausal woman, 59 yrs, presented with perennial DM2, diabetic retinopathy, nephropathy, hypertension, hyperlipidemia, hyperuricemia and obesity (BMI 39.8 kg/m²). She had weight gain for last 5 yrs, with expressed hirsutism (FGS 28). Despite basal-bolus insulin therapy glycemic control is poor (HbA₁c 9.6%). Diagnostic evaluation revealed normal serum cortisol in overnight 1 mg dexamethasone test (63.5 nmol/l), normal prolactin, TSH, SHBG, DHEAS, IGF-1, ACTH. Total testosterone (4.1 nmol/l) and free testosterone (72.9 pmol/l) were increased. MRI of abdomen and pelvis showed normal adrenal glands, myoma uteri (25.2×21.7×18 mm), left ovary solid, enlarged 29.3×19.5 mm, and right ovary 14.4×8.6 mm in size. Tumor marker CA125 was normal. The patient refused suggested gynecologic surgery, applying only cosmetic treatment.

Female, 58 yrs, presented with postmenopausal hirsutism (FGS 14) and alopecia; DM2, hypertension, hyperlipidemia, obesity (BMI 31.2 kg/m²). Total testosterone was 2.9 nmol/l and free testosterone 58.2 pmol/l. MR of abdomen and pelvis revealed enlarged ovaries. Bilateral ovariectomy was performed; PHD: Cellular steroid ovarian tumor. Signs of hyperandrogenism regressed, DM2 is well controlled with metformin.

Conclusion: Resolving the origin of androgen excess is important for adequate treatment. Ovariectomy in described cases resulted in regression of signs of hyperandrogenism.