Endocrine Abstracts

Background: 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 18. 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.