A Benign Cause of Hyperandrogenism in a Postmenopausal Woman

    February 2021 in “ Endocrinology, diabetes & metabolism case reports ”
    João Roque, Irina Alves, Ana Maria de Almeida Paiva Fernandes Rodrigues, Maria João Bugalho
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    TLDR A postmenopausal woman's excessive hair growth and hair loss were due to a non-cancerous ovarian condition, treated successfully with surgery.
    A 62-year-old postmenopausal woman presented with a 9-month history of progressive frontotemporal hair loss and hirsutism, with blood tests revealing elevated total testosterone levels of 5.20 nmol/L and a Free Androgen Index of 13.1, while DHEAS levels were normal. Despite negative imaging for adrenal or ovarian tumors, the persistent hyperandrogenism led to the hypothesis of an ovarian origin. Following bilateral salpingectomy-oophorectomy and total hysterectomy, the patient's ovaries were found to have stromal hyperplasia, and her testosterone levels normalized post-surgery with hirsutism subsiding after 8 months. The case underscores that hirsutism or virilizing features in postmenopausal women can indicate a benign condition like ovarian stromal hyperplasia, which can be treated effectively with surgery, and highlights the risk of peripheral aromatization leading to increased estrogen levels and potential endometrial cancer.
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