An 81-year-old lady was referred with a 2-month history of frontal balding and hirsutism over the face and chest that required daily shaving. Her symptoms were progressing weekly. She did not have any history of hot flushes, voice changes or weight loss. Clinical examination revealed marked hirsutism over the face, neck, upper back, thorax and abdomen with a fullness in the right iliac fossa. She had a past medical history of hypertension and hypercholesterolemia.
Investigations showed a testosterone of 21.8 nmol/l (0.11.5 nmol/l), androstenedione 7.1 nmol/l (03.5 nmol/l), dehydroepiandrosterone 1.9 μmol/l (04.6 μmol/l), free androgen index 43.8, estradiol 148 pmol/l (0200 pmol/l) and haemoglobin 160 g/l. Urgent CT scan of abdomen and pelvis confirmed a right ovarian cystic mass measuring 51×35×31 mm.
She was referred to the gynaecologists who performed a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histology revealed a 10 mm steroid cell tumour in the right ovary with a benign serous cyst. There was no evidence of metastases.
Repeat testosterone level and haemoglobin one month post-surgery was 1.1 nmol/l and 130 g/l respectively. She had made an uncomplicated post-operative recovery and had noticed a reduction in the greasiness of her hair.
Steroid cell tumours of the ovary are rare tumours accounting for <0.1% of all ovarian tumours. They are associated with androgenic changes with frequency ranging from 12 to 50%, which are slowly progressive. Our case presented with rapid onset of severe hirsutism over a 2-month period that was successfully treated with surgery, which remains the mainstay of management of such tumours.