ECE2019 Poster Presentations Reproductive Endocrinology 2 (39 abstracts)
Hyperandrogenism in postmenopausal women
Nerea Egaña Zunzunegui , Ismene Bilbao Garay , Maite Aramburu Calafell , Cristina Garcia Delgado , Leire Agea , Maite Perez de Ciriza Cordeu , Alfredo Yoldi Arrieta , Izaskun Olaizola Iregui & Miguel Maria Goena Iglesias
Hospital Donostia, San Sebastian, Spain.
Introduction: The presentation of new onset hyperandrogenism is extremely rare in postmenopausal women. In premenopausal women, the most common cause of androgen excess is polycystic ovary syndrome. In contrast, when hyperandrogenism develops in postmenopausal women, it is usually associated with other causes, such as ovarian hyperthecosis or an androgen secreting tumor. We describe 5 patients with hyperandrogenism (Table 1). Total Testosterone 0.06–0.86 ng/ml, free testosterone 2–12.8 ng/dl, DHEA-S 0.3–2.5 μg/ml, Androstendiona 0.21–4.5 ng/ml, FSH postmenopausal 26–139 U/l, LH postmenopausal 20–65 U/l, Estradiol postmenopausal <49 pg/ml, Hemoglobine 12–15.3 g/dl, Hematocrite 35–46%
| Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | |
| Age | 61 | 51 | 68 | 51 | 57 |
| Ferriman Galleway | 25 | 36 | 13 | 12 | 12 |
| Total testosterone | 4.41 | 3.16 | 13.2 | 6.9 | 0.68 |
| Free testosterone | 86.2 | 64.2 | 160.9 | 190.2 | 16.1 |
| DHEA-S | 0.61 | 1.71 | 0.34 | 55.2 | 1.63 |
| Androstenodione | 2.1 | 3.6 | 2.4 | 10 | 3.9 |
| FSH/LH | 61.8/20.1 | 23.5/19.1 | 52.6/40.6 | 31.9/14.5 | 31.9/18.5 |
| Estrogen | 25.7 | 29.5 | 31.9 | 50.2 | 13.4 |
| Nugent | 0.9 | 1.1 | 1.2 | 26 | 1.2 |
| Hb/Hemotocrite | 17.3/51.4 | 17.8/52.1 | 16.1/48.9 | 16/47.2 | 13.1/41.4 |
| Ovaric US | Normal | Normal | Tumor in Right ovary | Normal | Bilateral Solid tumor |
| Adrenal TC | Bilateral Adenoma | Bilateral Adenoma | Normal | Adrenal Carcinoma | Normal |
| Surgery | Bilateral Oophorectomy | Bilateral Oophorectomy | Bilateral Oophorectomy | Unresectable | Bilateral Oophorectomy |
| AP | Leydig Tumor | Leydig Tumor | Leydig Tumor | Hyperthecosis | |
| Normalization Androgenism | Yes | Yes | Yes | No | Yes |
Conclusion: Diagnosing the source of hyperandrogenism in postmenopausal women remains a clinical challenge. In post menopausal women with progressive hirsutism or virilization, it may be reasonable to consider bilateral oopherectomy in the setting of normal ovarian imaging and biochemical evidence of ovarian source of the hyperandrogenism. The combination of a detailed history, proper clinical assessment and appropriate laboratory and imaging evaluation is required for the accurate differential diagnosis and management.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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