Endocrine Abstracts

A 73-year-old lady presented to our department with a 6-month history of facial hirsutism and frontal hair loss. Her past medical history comprised of type 2 diabetes and hypertension. Initial blood tests showed testosterone 15.9 nmol/l (normal range 0–1.7), SHBG 123.6 nmol/l, LH 23.1 iu/l (normal range 16–64), FSH 33.5 iu/l (normal range 16–64), oestradiol 281 pmol/l (normal <43), mild erythrocytosis, mild hyperbilirubinaemia and HbA1c 56 mmol/mol (normal <42). Her DHEAS, androstenedione, short synacten test with 17-hydroxy progesterone, TSH and overnight dexamethasone suppression test were normal. Repeat testosterone levels, even with different asseys, remained elevated (highest 20.3 nmol/l). A CT scan showed normal adrenal glands, but severe liver cirrhosis and abdominal varices. Pelvic US and MRI showed normal ovaries. Ovarian hyperthecosis was suspected. Subsequently, she was referred to the Gastroenterology and Gynaecology teams and she underwent variceal banding and total abdominal hysterectomy with bilateral oophorectomy. Histopathology revealed ovarian hyperthecosis. Her post-op testosterone level was 1.1 nmol/l and oestradiol 43 pmol/l. Also, her hair started regrowing in the scalp and her hirsutism improved significantly. Ovarian hyperthecosis is a non-neoplastic disorder mainly diagnosed in postmenopausal women mimicking the clinical manifestations and metabolic sequel of PCOS. Aetiology is thought to be related to elevated postmenopausal gonadotropin levels. Patients typically present with a long history of slowly progressive hyperandrogenism often resulting in virilization. Testosterone is usually <7 nmol/l. Imaging shows bilaterally enlarged ovaries. The diagnosis is confirmed histologically. However, this was a case of histo-pathologically confirmed ovarian hyperthecosis with severe hyperandrogenaemia and normal ovarian imaging.