Hyperplasia: An Unusual Case of Virilization in a Postmenopausal Woman

OBJECTIVE:
To report an unusual case of ovarian Leydig cell hyperplasia resulting in virilization in a postmenopausal woman.

INTRODUCTION:
In a postmenopausal woman, evaluation of virilization includes ruling out a variety of causes before ovarian sampling or empiric oophorectomy.

Case Presentation:
64-year-old woman presented to the endocrinology office as a referral for evaluation of increasing hirsutism. She had a history of irregular menses and facial hirsutism since menarche, but since menopause at age 50, she noticed worsening hirsutism, diffuse hair loss, deepening of her voice, increased muscle mass, and increased libido.

Discussion:
The patients’ history of long-standing irregular menses and worsening hirsutism after menopause along with subsequent deepening voice, male musculature, and male alopecia, all accompanied by very high serum testosterone levels, prompted us to rule out late onset (CAH) and/or a small ovarian arrhenoblastoma.

Conclusion:
Though at least seven cases have been described of this pathology, it is important to take note of our patient’s presentation and final diagnosis for future work-ups in similarly presenting patients. With exclusion of adrenal origin and other obvious ovarian disease, virilization in postmenopausal women may be the result of Leydig cell hyperplasia for which a bilateral salpingooopherectomy or bilateral oophorectomy is the cure.

This article was published in Endocrine Practice

Endocrine Practice article link:

https://www.sciencedirect.com/science/article/abs/pii/S1530891X20420403