In postmenopausal women with clinical hyperandrogenism Cushings syndrome and adrenal/ovarian neoplasms must be excluded, but radiological and biochemical studies are not always useful for localizing the source of androgens.
Case 1: A 75-year-old woman developed alopecia and progressive hair growth on the chest and abdomen over 4 months. Five years before a successful parathyroidectomy had been carried out. Hormonal evaluation: Testosterone (T): 5.84 ng/ml; DHEAs: 0.44 mg/l; Androstenedione (A): 2.76 ng/ml. Abdominal CT found no tumours. Transvaginal ultrasound of the ovaries was normal, and MRI identified an uncertain small nodule in the left parametrium. Anexectomy and bilateral ooforectomy was performed, and histology identified two mesoovaric tumours of 6 and 12 mm (right and left), both Leydig cell tumours. One month after, hormones were: T: 0.1; A: 2.0. Six months later alopecia and hirsutism were resolved.
Case 2: A 53-year-old woman referred by dyslipidemia and hypertension. She had suffered an acute myocardial infarction 3-year before. She had noticed hair growth for the last year, particularly in shoulders, acral enlargement and increasing weight. Acromegaly was ruled out by oral glucose tolerance test but revealed DM2. Hormonal evaluation: T: 2.98; DHEAs: 0.4; A: 4.8 ng/ml. Abdominal CT: 27 mm right adrenal hypointense mass and normal ovaries. Transvaginal ultrasound: ovaries slightly enlarged. After uneventful laparoscopic adrenalectomy, androgen levels remained high. Bilateral ooforectomy was performed. Histology identified ovaries of 60×30×20 mm with diffuse stromal hyperplasy, and scattered groups of luteinized cells. Three months later, she had T: 0.2 and A: 1.6 ng/ml. Glycemic control improved and hirsutism reverted 6 months later.
Conclusion: We described two unusual cases. The first emphasizes the finding of bilateral Leydigs tumour, scarcely reported. The second pays attention on the association of stromal hyperthecosis, hyperandrogenism and metabolic disturbances. Finding an incidental adrenal adenoma illustrates the troublesome diagnosis in this pathology.