Endocrine Abstracts

Hyperandrogenism in postmenopausal females is rare and always mandates investigation. It may be due to an ovarian or adrenal source of androgen production. A 75-year-old post-menopausal woman was referred by her dermatologist for investigation of severe hyperandrogenaemia (testosterone 30.6nmol/l, RI <1.4; LH and FSH undetectable), on background of polycythaemia (previously felt to be idiopathic). She had a 3-year history of androgenic alopecia (resistant to spironolactone and minoxidil) and virilisation (Ferriman Gallwey score 32/36, Ludwig scale 3/3). DHEAS levels, overnight dexamethasone suppression testing, and adrenal imaging were normal. Both ovaries were enlarged, with multiple small follicles and a mildly thickened endometrium on pelvic MRI. Pathology from a subsequent hysterectomy and bilateral salpingo-oophorectomy revealed a steroid cell tumour of the left ovary. Following surgery, the patient lost 5 kg in weight, testosterone level fell (<0.4nmol/l), LH and FSH rose (30, 23 IU/l respectively), polycythaemia resolved (Hgb 14.4g/dl), and her plethora, hirsutism and alopecia improved (Ferriman Gallwey score 17/36, Ludwig scale 2/3). The patient had presented to multiple physicians over years, with conditions potentially related to hyperandrogenaemia, prior to measurement of testosterone concentration. Investigations suggested an ovarian source of androgens, and although imaging did not identify a suspected tumour, the height of elevation of testosterone was most in keeping with a steroid-producing ovarian tumour, so oophorectomy was the best course of action. Her case highlights the need to consider unusual causes of hirsuitism and polycythaemia and the need for prompt investigation and management of post-menopausal hyperandrogenaemia.