Endocrine Abstracts

Approximately 10% of the female present with features of hyperandrogenism in their life. It is common in adolescent and childbearing age and less common in menopausal age. A 56-year-old female with a history of type 2 diabetes mellitus, hypertension presented with progressively worsening features of virilization for 1 year. Patient had severe hirsutism, androgenic alopecia and clitoromegaly. She had no loss of weight, loss of appetite suggestive of underlying malignancy. However, there was no clinical evidence of Cushing’s syndrome, no evidence of worsening hypertension or paroxysms suggestive of pheochromocytoma. She had no clinical evidence of increased pigmentation, postural dizziness suggestive of late onset congenital adrenal hyperplasia. She is a mother of one and she had no history of oligomenorrhoea or subfertility suggestive of poly cystic ovary syndrome. She became menopausal at the age of 45 and not on hormonal supplements. Investigations found to have high serum total testosterone levels (23.5 nmol/l), free androgen index was 95, and other adrenal hormones were within the normal range. Her contrast enhanced computer tomography (CECT) abdomen did not reveal any abnormality of the adrenals or ovaries. She was offered bilateral adrenal and ovarian venous sampling. It revealed excess testosterone secretion from her left ovary. She underwent laparoscopic bilateral salphingoophorectomy and hysterectomy. Histology found to have stromal cell hyperplasia without evidence of malignancy. She recovered clinically and biochemically following surgery. However severe hyperandrogenism causing virilisation is rare. In post-menopausal women, some of these clinical manifestations could be physiological. However careful evaluation and treatment needed in these patients as these symptoms could be pointing towards neoplastic or functional disease.