Introduction: Leydig cell tumors are a type of steroid cell tumor, account for 0.1% of all ovarian tumors. The clinical presentation is usually a hyperandrogenic state with signs of virilisation. The tumor has a benign behavior, with an excellent prognosis and reversion of symptoms after surgical treatment.
Case report: Woman, 81 years-old, nulliparus, with clinic hyperandrogenism and vaginal bleeding during the last year. She had history of dementia syndrome, dyslipidemia, psoriasis, primary infertility. Her family history was irrelevant. The physical examination revealed hirsutism, androgenic alopecia, masculine voice, and clitoromegaly without adnexial masses in gynecology examination. She had no features of Cushing syndrome. Total testosterone (7.4 ng/ml (0.060.82)) and delta 4-androstenedione (>10 ng/ml (0.302.99)) were elevated and other hormonal serum levels were normal namely DHEA-S, 17-hidroxiprogesterone, prolactin and TSH. Transvaginal ultrasound revealed intramural fibroid, without visualization of adnexial masses. Abdomino-pelvic computerized tomography (CT) revealed a nodule with 30 mm in the left ovary and normal adrenal glands, confirmed by abdomino-pelvic magnetic resonance. A complete hysterectomy and bilateral oophorectomy were performed. Histological examination revealed a Leydig cell tumor of the ovary. After surgery, the androgen serum levels normalized.
Discussion: The rapid onset of clinical hyperandrogenism with virilism and a serum testosterone level higher than 2.0 ng/ml raised suspicion of an androgen production tumor. In a hyperandrogenism presenting patient, a complete gynecology examination should be performed and an adrenal and ovary CT should be done to exclude an androgen production tumor.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.