Endocrine Abstracts

JOINT2414

Introduction: Hirsutism can be caused by many factors, which can be divided into distinct phenotypes: ovarian, adrenal, other endocrinopathies, iatrogenic and idiopathic. Hyperandrogenism manifests itself through excessive body hair growth in male pattern, balding in the male pattern, acne, menstrual disorders and deeper voice. Ovarian Leydig cell tumors are a rare type of androgen-secreting tumor. They account for less than 0.1 % of all ovarian neoplasms and are predominantly unilateral, benign, and found in the ovarian hilum.

Case presentation: The phenotypic characteristics of a 64-year old female patient showed the presence of features of hyperandrogenism. The hirsutism was evaluated at 18/36 on the Ferriman-Gallwey scale. Male type androgenic alopecia presented as hair loss in front of the scalp. Excessive face hair was removed by laser treatment. The patient reported rare pains in the abdomen, but she indicated that first symptoms of excessive body hair appeared 3 years before being admitted. The gynecological history was regular (normal monthly cycles until menopause at the age of 47, pregnant 2 times). Laboratory tests and imaging examinations were performed. Total testosterone was increased to 12.9 nmol/l(normal range for females up to 1.0 nmol/L), FAI index was high at 40.3, androstendion and DHEAS were normal. Erythrocytosis was also present, (4.93 g/dl; normal range for females up to 4.0 g/dl). Cushing syndrome, PCOS and other causes of hirsutism were excluded. Initial transvaginal ultrasound was normal. Abdominal computer tomography (CT) showed intraductal papillary mucinous neoplasm, ovaries were described as normal. Control abdominal ultrasound showed slightly enlarged right ovary, high total testosterone and erythrocytosis were persistently showing in laboratory tests. Patient was referred to gynecologist for bilateral adnexectomy. One year later the removal of adnexa on both sides was performed. Histopathologic examination revealed a 1 cm Leydig cell tumor in hilum of the enlarged right ovary.

Conclusion: A case of unilateral Leydig cell tumor in an initially normal sized ovary under abdominal ultrasound and CT in postmenopausal female is described. Our case highlights the importance of thorough pelvic examination as well as consideration of steroid cell tumors causing androgen excess even if ovaries appear normal in size. Radiological studies alone are not enough to diagnose ovarian pathology, as often any such lesions will be small and the affected ovary within the expected normal size. Excess androgens and erythrocytosis combined with hirsutism in the absence of other endocrinopathies should raise the suspicion of a Leydig cell ovarian tumor.