Virilizing ovarian tumors are a rare cause of hyperandrogenism; they account for 12% of all ovarian tumors being the Leydig cell tumor the most common one.
We report the case of a 76-year old woman with type 2 diabetes that was referred for androgenic alopecia with 3 years evolution and a recent facial, peri-areolar and dorsal hirsutism. A diagnosis of hypertension was made 18 months previously, and she was on a four anti-hypertensive drug regimen. On examination she had central obesity (BMI 34.5 kg/m2), hypertension (180/110 mmHg) and hirsutism (score 18); there was no clitoromegaly, cutaneous bruising or striae. Laboratory tests showed normal ACTH, cortisol, S-DHEA and androstenedione but elevated total testosterone- 1.7 ng/ml (0.40.8) and free testosterone- 3.9 pg/ml (<1.55); 1 mg dexamethasone suppression test and ACTH stimulation test were normal. Endovaginal ultrasound and abdominal CT scan showed no evidence of adrenal or ovarian masses. She was submitted to bilateral salpingo-oophorectomy. Histopathological studies revealed a left 1 cm ovarian Leydig cell tumor. Post-operatively testosterone declined to normal levels and an improvement in alopecia and hirsutism was obtained in the following 6 months.
In post-menopausal women the appearance of signs of masculinization and high testosterone levels are suggestive of an ovarian virilizing tumor. Although endovaginal ultrasound is useful for the diagnosis, it was negative in this patient, and clinical and biochemical criteria were determinant for surgery.
30 Apr - 04 May 2011
European Society of Endocrinology