P-35 Luteinized Thecoma in a postmenopausal woman with Hirsutism

Abstract

Abstract Introduction We present a 59-year-old postmenopausal woman with a history of obesity and hypertension who sought medical attention due to severe hirsutism. She had been taking various medications, including levotiroksin for thyroid hormone replacement, asetyl salicylic acid as an antiplatelet agent, Betahistin for vertigo, and amlodipine 10 mg for hypertension. Clinical Case The patient had been experiencing severe hirsutism for a year and her complaining had been deteriorating. Her past medical history was significant for obesity and hypertension. She had undergone menopause ten years ago. Her hirsutism, and obesity prompted further investigation into her hormonal profile and pelvic health. On physical examination, the patient's height was 153 cm, and her weight was 109.7 kg, with a BMI of 46.6. Notably, she exhibited severe hirsutism, with Feriman Gallway score of 15. The patient's laboratory results revealed TSH level was elevated at 4.98 mIU/L, indicating subclinical hypothyroidism. Further hormonal evaluation showed increased FSH levels (40 IU/L) and LH levels (12 IU/L), consistent with diminished ovarian function. DHEAS (dehydroepiandrosterone sulfate) level was 121 µg/dL, PRL (prolactin) was 7 ng/mL and both were between normal ranges. Total testosterone level (416,09 ng/dL) and estradiol level was 34.11 pg/mL (0 - 32,2 pg/mL for postmenopausal women) were increased. Free testesteron was increased (22 nmol/L) and 17-α hydroxyprogesterone was 0,61 ng/mL. Cortisol after 1mg-dexamethasone suppression test (1-mg DST) was 0.65 ug/dl. In March 2021, the patient underwent a pelvic ultrasound, which was inconclusive due to obesity. However, no masses were detected in the ovaries. An abdominal MR was also performed, revealing no significant findings in the ovaries. She was prescribed spironolactone 100 mg per day and orlistat for weight loss. In November 2021, the patient underwent surgery due to the discovery of a left-sided sex cord-stromal tumor during the pelvic examination. The histopathological examination confirmed the diagnosis of "Luteinized Thecoma" in the left ovary. The tumor was composed of luteinized cells capable of producing androgens, explaining the patient's hirsutism. Following the surgery, the patient experienced a reduction in hirsutism, possibly due to the removal of the hormonally active tumor. Moreover, she exhibited weight loss since the last prescription, with her weight reducing to 98.3 kg, resulting in a BMI of 41.4. Conclusion Hyperthecosis is mostly reported in postmenopausal women, affecting less than 1% of women of reproductive age. This case illustrates the diagnostic journey of a postmenopausal woman with hirsutism. The discovery of a Luteinized Thecoma, a rare sex cord-stromal tumor, explains the patient's hirsutism.