ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P1134 | DOI: 10.1530/endoabs.63.P1134

Hyperandrogenism in postmenopausal women

Nerea Egaña Zunzunegui, Ismene Bilbao Garay, Maite Aramburu Calafell, Cristina Garcia Delgado, Leire Agea, Maite Perez de Ciriza Cordeu, Alfredo Yoldi Arrieta, Izaskun Olaizola Iregui & Miguel Maria Goena Iglesias

Hospital Donostia, San Sebastian, Spain.

Introduction: The presentation of new onset hyperandrogenism is extremely rare in postmenopausal women. In premenopausal women, the most common cause of androgen excess is polycystic ovary syndrome. In contrast, when hyperandrogenism develops in postmenopausal women, it is usually associated with other causes, such as ovarian hyperthecosis or an androgen secreting tumor. We describe 5 patients with hyperandrogenism (Table 1). Total Testosterone 0.06–0.86 ng/ml, free testosterone 2–12.8 ng/dl, DHEA-S 0.3–2.5 μg/ml, Androstendiona 0.21–4.5 ng/ml, FSH postmenopausal 26–139 U/l, LH postmenopausal 20–65 U/l, Estradiol postmenopausal <49 pg/ml, Hemoglobine 12–15.3 g/dl, Hematocrite 35–46%

Table 1
Case 1Case 2Case 3Case 4Case 5
Ferriman Galleway2536131212
Total testosterone4.413.1613.26.90.68
Free testosterone86.264.2160.9190.216.1
Ovaric USNormalNormalTumor in Right ovaryNormalBilateral Solid tumor
Adrenal TCBilateral AdenomaBilateral AdenomaNormalAdrenal CarcinomaNormal
SurgeryBilateral OophorectomyBilateral OophorectomyBilateral OophorectomyUnresectableBilateral Oophorectomy
APLeydig TumorLeydig TumorLeydig TumorHyperthecosis
Normalization AndrogenismYesYesYesNoYes

Conclusion: Diagnosing the source of hyperandrogenism in postmenopausal women remains a clinical challenge. In post menopausal women with progressive hirsutism or virilization, it may be reasonable to consider bilateral oopherectomy in the setting of normal ovarian imaging and biochemical evidence of ovarian source of the hyperandrogenism. The combination of a detailed history, proper clinical assessment and appropriate laboratory and imaging evaluation is required for the accurate differential diagnosis and management.

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