Introduction: The polycystic ovary syndrome is the commonest cause for hyperandrogenism in young women. However, in older women, adrenal and ovarian tumours are more common, particularly if (a) hyperandrogenism is of short duration, (b) causes significant clinical androgenisation, and (c) is biochemically severe. We present an elderly woman who presented diagnostic and therapeutic challenges on account of her comorbidities.
Case Presentation: A 67-year-old woman had a 4-month history of excessive hair growth and alopecia. She had COPD, diabetes mellitus, and peripheral vascular disease but didnt take offending medications. Clinically, she had significant facial, abdominal, and trunk hirsutism (Ferriman-Gallwey score 27), but no signs of Cushings syndrome. She also had significant alopecia and temporal recession. Examination of her systems was normal. Investigations showed - Plasma testosterone - 46.8 and 50 nmol/l, DHEAS - 10 nmol/l, androstenedione - 7.5 nmol/l; 17 hydroxy progesterone (17HP) - 11.6 nmol/l; overnight dexamethasone suppression test 9 am cortisol < 28 nmol/l; dexamethasone androgen suppression test - plasma cortisol.
Discussion: This patient presented with rapid onset, severe clinical and biochemical hyperandrogenism, suggesting an androgen secreting tumour. This was proved to be ovarian (androgen suppression test while awaiting selective venous sampling), and benign (lack of growth on interval scans 7 months apart) after investigations. She was unfit for surgery, and was therefore given cyproterone acetate with normalisation of androgen levels and clinical improvement.