Endocrine Abstracts

Introduction: Nearly 10% of all women have experienced hirsutism with hyperandrogenism at some stage in their life. Endogenous sources of androgen excess include ovarian tumours, ovarian hyperthecosis, and adrenal tumors. We present a case highlighting the work-up of hyperandrogenism.

Case report: A 47-year-old female, with background of type 2 diabetes, hypertension, polycystic ovarian syndrome (PCOS), obesity, was noted to have significant androgenisation incidentally in diabetes foot clinic. She had a long history of hirsutism from her 20’s but developed deepening of voice, worsening of hirsutism with whole body shaving on alternate days, and androgenic hair loss for two years. She had menarche at 12 years and became hypomenorrhea from her 20’s and amenorrhoea for the last few years. She is sexually active but never had confirmed pregnancy without any contraception. There was no significant family history of hirsutism. On examination, male pattern body habitus and male pattern baldness, BMI 42 kg/m², modified Ferriman-Gallwey score was 29/36, and clitoromegaly. She was obese but not Cushingoid. Her regular medications included metformin, insulin, dapagliflozin, dulaglutide, amlodipine, ramipril and aspirin. Blood investigations were done in 12years ago during the diagnosis of PCOS and during this referral and results are as tabulated below. CT adrenals was unremarkable with normal appearance of adrenals. Ultrasound of the ovaries showed normal endometrial thickness, enlarged left ovary but right ovary not visualized. Urgent MRI of pelvis has been organised. She was started on flutamide, non-steroidal anti-androgen, along with desogestrel, contraceptive, as sexually active and tolerated well without any side-effects.

Discussion: High testosterone in women may be due to polycystic ovary syndrome, congenital adrenal hyperplasia, ovarian tumours, ovarian hyperthecosis, and adrenal tumors. Ovarian hyperthecosis is associated with high testosterone levels, affecting less than 1% of women in the child-bearing age. In our case, there was partial suppression after overnight dexamethasone along with reassuring radiology pointing towards ovarian hyperthecosis as underlying etiology as initial significantly high testosterone should make the clinician suspicious towards malignancy.