Endocrine Abstracts

Background: Hyperandrogenism in postmenopausal women is uncommon and warrants thorough evaluation due to the potential for androgen-secreting tumours. Leydig cell tumours are rare ovarian neoplasms that typically present with virilising symptoms and biochemical evidence of hyperandrogenism.

Case Presentation: We report the case of an 80-year-old Caucasian woman referred for evaluation of progressive androgenic alopecia and markedly elevated testosterone levels (16 nmol/l). Investigations showed a high free androgen index and low-normal sex hormone-binding globulin, without signs of virilisation beyond alopecia. Gonadotrophins were low for postmenopausal levels, and oestradiol was elevated. Computed tomography revealed a bulky right ovary and a left adrenal adenoma. Although dehydroepiandrosterone sulfate was mildly raised, the degree of testosterone elevation strongly suggested an ovarian source. She underwent bilateral salpingo-oophorectomy. Histology confirmed a 20 mm Leydig cell tumor in the right ovary and Leydig cell hyperplasia in the left. Post-operative follow-up showed normalisation of androgen levels and gonadotrophin recovery.

Discussion: Leydig cell tumours account for less than 0.1% of ovarian neoplasms and predominantly affect postmenopausal women. (1) They are often small and may not be detectable on imaging. This case highlights the diagnostic challenges posed by co-existing adrenal incidentalomas and underscores the importance of considering ovarian androgen-secreting tumours in post menopausal women with isolated hyperandrogenism. Surgical resection remains the mainstay of treatment, with excellent prognosis.

Conclusion: This case emphasises the need for a high index of suspicion for ovarian Leydig cell tumors in postmenopausal women presenting with severe hyperandrogenism, even in the absence of obvious virilisation or definitive imaging findings.

Reference: 1. Bužinskienė D, Rūta Marčiukaitytė, Šidlovska E, Vilius Rudaitis. Ovarian Leydig Cell Tumor and Ovarian Hyperthecosis in a Postmenopausal Woman: A Case Report and Literature Review. Medicina-lithuania. 2023 Jun 6;59(6):1097–7.