Endocrine Abstracts

Introduction: Progressive hirsutism and moderate to severe male-pattern balding in women requires exclusion of an adrenal or ovarian tumor.

Case presentation: A 51-year-old lady presented with excessive hair on her face and lower abdomen of 1 year duration which affected her quality of life. Her menopause started 3 years ago. Her body mass index was 28.6 kg/m². She had hair on her upper lip, chin, and lower abdomen; she had a Ferriman–Gallwey score of 10. On examination the patient was normotensive, with male pattern baldness. A hormone profile revealed a markedly elevated serum testosterone of 3.7 µg/l (<0.47), androstenedione of 6.1 ng/mL (0.35–2.49 ng/mL) and a free androgen index 67% (0.19-3.63%). Cortisol, prolactin, growth hormone and thyroid function tests, glycemic profile were normal. A CT scan of the abdomen and pelvis revealed a 21 mm right ovarian mass and multiple uterine fibroids with normal adrenal glands. The patient underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Histology confirmed the presence of a Leydig cell tumour, confined to the right ovary, with no malignant features. Postoperatively her androgen levels normalized and symptoms resolved within 10 weeks.

Conclusion: In postmenopausal women with new onset of hirsutism that is severe or rapidly progressive, the possibility of an androgen-secreting tumor must be suspected and detailed history and physical examination, substantiated by focused biochemical and morphological confirmation is necessary.