title: Hyperandrogenism in post-menopausal women: a diagnosis challenge.
abstract: A 79-year-old woman, presented with increased hair growth in the chin and the upper lip but no in other androgen-dependent areas of her body. Hormonal evaluation showed markedly elevated serum testosterone level (>1.7 ng/ml) and normal DHEA-S, androstenedione, 17-hydroxyprogesterone, cortisol and TSH levels. The diagnosis of probable pure testosterone secreting tumor was made. Transvaginal ultrasound and magnetic resonance image revealed a 16 mm × 12 mm nodular formation indicative of an atypical adenoma in the left adrenal gland and a tube-shaped, fluid-filled, thin-walled image measuring 28 mm × 14 mm suggestive of a hydrosalpinx in the right ovary. Differential diagnosis between the coexistence of an androgen-producing ovarian tumor (occult) associated with a finding of an adrenal image (Incidentaloma) or an adrenal tumor secreting testosterone only was done. Since cortisol levels went down, but total testosterone inhibition did not occur after suppression with dexamethasone. An ovarian androgen secreting tumour was suspected and surgery was performed. Histological examination showed a Leydig cells hyperplasia. After the operation testosterone returned to normal with regression of clinical symptoms.
authors.affiliation: Department of Obstetrics and Gynecology and.
authors.forename: Marta
authors.initials: M
authors.lastname: Tutzer
authors.forename: Irina
authors.initials: I
authors.lastname: Winnykamien
authors.forename: Jhery
authors.initials: J
authors.lastname: Davila Guardia
authors.forename: Camil
authors.initials: C
authors.lastname: Castelo-Branco
mesh_terms: D000368:Aged; D018293:Cystadenoma, Serous / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006628:Hirsutism / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D017588:Hyperandrogenism / Q000175:diagnosis* / Q000209:etiology; D007984:Leydig Cell Tumor / Q000150:complications / Q000175:diagnosis*; D010051:Ovarian Neoplasms / Q000150:complications / Q000175:diagnosis*; D017698:Postmenopause / Q000502:physiology