THU646 Postmenopausal Hyperandrogenism Secondary To Ovarian Leydig Cell Tumor

Abstract

Abstract Disclosure: J.T. Batch: None. G.Y. Gandhi: None. Introduction: Hirsutism is typically the initial presentation of virilization, including male pattern balding, deepening of the voice, and clitoromegaly. Postmenopausal hyperandrogenism can originate from adrenal or ovarian causes. This report describes marked hirsutism and scalp hair loss in a patient, leading to significant negative psychological and social impacts. Case Report: A 73-year-old female presented to the clinic complaining of scalp hair loss and increased facial hair in the upper lip and chin. She has hypertension (treated with amlodipine, losartan, metoprolol tartrate, and hydrochlorothiazide), dyslipidemia (treated with omega-3 fatty acids), hypothyroidism (treated with levothyroxine), and transvaginal hysterectomy without oophorectomy in 1994 for menorrhagia (no hormonal replacement therapy after surgery). The patient reported regular menstrual periods before the hysterectomy but developed menorrhagia during her early 50s. For the past five years, she noted bitemporal scalp hair loss that progressed significantly and created recession of the hairline and thinning of hair in her crown area. She developed dark pigmented hair on her upper lip and chin area, lower abdomen, and chest. Due to the significant impact of these physical changes, she became socially withdrawn and admitted to only leaving home to attend doctors’ appointments. She denied using supplements or physical contact with anyone using topical testosterone. She denied enlargement of her clitoris. She did note a deepening of her voice, although she is a chronic smoker. A hormonal work-up revealed a significantly high total testosterone of 511 ng/dL (normal range 2-45 ng/dL). DHEA-sulfate was normal at 62 mcg/dL (4-157 mcg/dL), and 17-hydroxyprogesterone was not significantly high at 192 ng/dL. MRI abdominal and pelvis with and without contrast revealed a 1.8 cm avidly enhancing left ovarian nodule. The patient underwent bilateral salpingo-oophorectomy. Pathology showed tumor cells with eosinophilic cytoplasm, central nucleus, and prominent nucleolus, consistent with a Leydig cell tumor measuring 1 cm and was confined to the left ovary. Four weeks after surgery, a repeat hormonal work-up revealed a normal total testosterone level of 23 ng/dL (normal range 2-45 ng/dL). Discussion: Hyperandrogenism with rapidly progressing hirsutism indicates a tumoral etiology. Leydig cell ovarian tumors are uncommon neoplasms arising from the gonadal stroma, accounting for <0.1% of all primary ovarian tumors. The diagnosis is based mainly on clinical and laboratory data since imaging studies may not show the small androgen-producing lesion. Bilateral oophorectomy should be recommended in postmenopausal women when an ovarian source is suspected. Most ovarian virilizing tumors are benign, and bilateral salpingo-oophorectomy results in a cure. Presentation: Thursday, June 15, 2023