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Diagnosis and Treatment > Signs and Symptoms

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  • Virilisation (abnormal) x
  • Face - coarse features x
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Khaled Aljenaee Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland

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Sulaiman Ali Departments of Endocrinology

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Seong Keat Cheah Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland

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Owen MacEneaney Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland

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Niall Mulligan Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland

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Neil Hickey Department of Radiology, Connolly Hospital Blanchardstown, Dublin, Ireland

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Tommy Kyaw Tun Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland

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Seamus Sreenan Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland

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John H McDermott Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland

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Markedly elevated androgen levels can lead to clinical virilization in females. Clinical features of virilization in a female patient, in association with biochemical hyperandrogenism, should prompt a search for an androgen-producing tumor, especially of ovarian or adrenal origin. We herein report the case of a 60-year-old woman of Pakistani origin who presented with the incidental finding of male pattern baldness and hirsutism. Her serum testosterone level was markedly elevated at 21 nmol/L (normal range: 0.4–1.7 nmol/L), while her DHEAS level was normal, indicating a likely ovarian source of her elevated testosterone. Subsequently, a CT abdomen-pelvis was performed, which revealed a bulky right ovary, confirmed on MRI of the pelvis as an enlarged right ovary, measuring 2.9 × 2.2 cm transaxially. A laparoscopic bilateral salpingo-oophorectomy was performed, and histopathological examination and immunohistochemistry confirmed the diagnosis of a Leydig cell tumor, a rare tumor accounting for 0.1% of ovarian tumors. Surgical resection led to normalization of testosterone levels.

Learning points:

  • Hirsutism in postmenopausal women should trigger suspicion of androgen-secreting tumor

  • Extremely elevated testosterone level plus normal DHEAS level point toward ovarian source

  • Leydig cell tumor is extremely rare cause of hyperandrogenicity

Taxonomy:
Clinical Overview, Gland/Organ, Ovaries, Topic, Andrology, Hormone, FSH, Testosterone, Condition/ Syndrome, Hyperandrogenism, Leydig cell tumour, Ovarian tumour, Patient Demographics, Age, Adult, Gender, Female, Ethnicity, Asian - Pakistani, Country of Treatment, Ireland, Diagnosis and Treatment, Signs and Symptoms, Clitoromegaly, Face - coarse features, Hirsutism, Hyperandrogenism, Virilisation (abnormal), Investigation, CT scan, DHEA Sulphate, FSH, Histopathology, Immunohistochemistry, MRI, Testosterone, Intervention, Bilateral salpingo-oophorectomy, Related Disciplines, Gynaecology, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-17-0075
Volume/Issue:
Volume 2017: Issue 1
Open access