Endocrine Abstracts

Introduction: Ovarian dermoid cysts, also known as mature cystic teratomas, are a very rare cause of virilization. Virilization in such cases is usually secondary to Sertoli-Leydig tumours, Leydig cell hyperplasia or Sertoli cell tumour. In some cases, no clear explanation for hyperandrogenism is found. Surgical excision of dermoid cyst results in normalization of androgen levels and resolution of symptoms.

Case Presentation: A 58-year-old female was referred with a short history of new onset hirsutism affecting her face, chest and abdomen, scalp hair thinning, increased muscularity, deepening of voice and reduced breast size. Her symptoms started 12 months previously and were rapidly progressive. Examination showed facial and body hirsutism, increased muscularity, androgenic alopecia, and deep voice. There were no clinical features suggestive of Cushing’s syndrome or insulin resistance. Investigations confirmed a markedly elevated testosterone (16.9 nmol/l), FSH and LH in the post-menopausal range and normal androstenedione, DHEAS and 17-OH-Progesterone levels. Overnight dexamethasone suppression test (ODST) was normal. Pelvic ultrasound showed a large complex cyst in the left adnexa suggestive of a dermoid cyst. CT scan of abdomen and pelvis confirmed the presence of a left adnexal lesion suggestive of an ovarian dermoid cyst and a bulky left adrenal gland. An adrenal protocol CT scan showed density and washout characteristics suggestive of an adrenal adenoma. The ovarian cyst was surgically excised, and histopathology confirmed ovarian dermoid cyst with an associated Sertoli cell tumour. Testosterone levels normalized after surgery and the patient reported significant improvement in her symptoms. Whilst it is important to rule out adrenal and ovarian tumours in postmenopausal women presenting with virilization, this case highlights the importance of considering other, less common causes of hyperandrogenism. A high index of suspicion remains the cornerstone of diagnosis.