Endocrine Abstracts

Background

In postmenopausal women, rapidly progressive hirsuitism or virilization raises the suspicion of an androgen-secreting tumor. Adrenal tumours are usually ruled out by hormonal testing and imaging studies. Small virilizing ovarian tumours may not be detectable by imaging studies.

Case

A 61-year-old woman presented with hirsutism and male-pattern baldness developing over a two year period. 40 years previously, she was undergone total abdomanal hysterectomy and left oopherectomy. Initial endocrine evaluation revealed elevated serum concentrations of total testosterone 12.8 nmol/l (N: 0.0–3.4 nmol/l) with normal sex hormone binding globulin, dehydroepiandrosterone-sulfate, androstenedione, 17-hydroxyprogesterone, and cortisol. Overnight dexamethazone suppression test and 24 h urine collection for cortisol were also normal. CT scan of the the abdomen and pelvis was unremarkable. Transvaginal ultrasonography was negative. A laparoscopic right oophorectomy was performed and 17 mm (in diameter) Leydig cell tumour of hilus cell type was detected on histologic examination. 2 months later at outpatient clinic follow up, she had a regression of the hirsutism and her plasma testosterone level returned to normal (<0.1 nmol/l).

Comment

Androgen-secreting ovarian tumors may represent a diagnostic and therapeutic challenge. This case illustrates th limitations of conventional imaging techniques and highlights the importance of proceeding to laparoscopy in the setting of recent-onset virilization with biochemical evidence of ovarian cause and normal adrenal imaging.