A Rare Cause of Hyperandrogenism in Postmenopausal Women: Ovarian Stromal Hyperplasia

    October 2024 in “ Journal of the Endocrine Society ”
    Stephen Mark, Michael Shanik, Isabela J Romao
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    TLDR Ovarian stromal hyperplasia can cause high testosterone in postmenopausal women and is treated by removing the ovaries.
    Ovarian stromal hyperplasia (OSH) is identified as a rare cause of hyperandrogenism in postmenopausal women, characterized by non-neoplastic proliferation of ovarian stromal cells leading to excessive testosterone production. The case study of a 49-year-old postmenopausal woman with a history of polycystic ovary syndrome, type 2 diabetes, and obesity, who presented with hirsutism, highlights the condition. Despite normal results from a dexamethasone suppression test and imaging showing no masses, bilateral salpingo-oophorectomy confirmed OSH, normalizing testosterone levels and improving hair distribution. OSH is rare, with about 1 case per 1000 hirsutism cases, and is associated with obesity, insulin resistance, and acanthosis nigricans. Diagnosis is confirmed through histological evaluation post-oophorectomy, which is curative, though GNRH agonist therapy is an alternative for non-surgical candidates. The study emphasizes the importance of considering OSH in differential diagnoses for timely treatment.
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