Endocrine Abstracts

Background: Ovarian fibrothecomas are rare, typically benign tumours that can cause postmenopausal virilization, such as hair loss. Most are hormonally inactive, with functioning tumours representing less than 0.1% of ovarian neoplasms.

Case presentation: A 78-year-old postmenopausal woman with a background of chronic kidney disease, hypertension, and hyperlipidaemia was referred to the endocrinology clinic for male pattern androgenic alopecia and spontaneous bruising over six months. Her initial blood tests showed significantly elevated free testosterone at 279 (1-20 pmol/l) and total testosterone 14.3 (0.101-1.42nmol/l). Her observations showed BP 172/73 mmHg, HR 79 bpm, height 159 cm and weight of 60 kg. Clinical examination found signs of androgenic pattern hair loss and revealed a noticeably deep voice. Further biochemical investigations showed LH 52.4 (2.4-12.6iu/l), FSH 76.3 (3.5-12.5iu/l), 17b-oestradiol 119 (114-332 pmol/l), prolactin 520 (102-496miu/l), TSH 2.03 (0.27-4.2mu/l), T4 13.8 (11.1-22 pmol/l), DHEA 0.8 (0.9-2.1umol/l), cortisol 323 (133-527nmol/l), androstenedione 4.8 (2-5.4nmol/l) and urine cortisol 34 (0-486nmol/d). An adrenal CT scan revealed no evidence of adrenal hyperplasia or masses. Due to strong suspicion of an ovarian tumour, a transvaginal ultrasound was performed but failed to detect any pelvic mass. However, an MRI of the pelvis identified a 4.2 cm solid mass in the right adnexal region. The patient underwent laparoscopic bilateral salpingo-oophorectomy, removing a 6 cm tumour from the right. Histology confirmed an ovarian cellular fibroma with luteinized cells, hyaline plaques, and a 2mm nodule of Leydig cell hyperplasia. The left ovary had a smaller fibroma with stromal hyperplasia and hyperthecosis. Following surgery, the patient’s virilism symptoms resolved, and her total testosterone levels normalized to <0.1nmol/l.

Conclusion: This rare case of bilateral testosterone-secreting fibrothecomas underscores the need to recognize signs and symptoms of virilization as potential indicators of ovarian pathology in postmenopausal women, even without abnormal bleeding, and highlights the importance of timely diagnosis and intervention.