The Case of the Elusive Androgen

In 2002, a case report detailed a 62-year-old post-menopausal woman with severe hirsutism and scalp alopecia, unresponsive to spironolactone treatment, who had an abnormally high testosterone level of 644 ng/dL. Initial surgery, including a total abdominal hysterectomy and bilateral oophorectomy, revealed bilateral hilar cell hyperplasia in the ovaries, but did not normalize testosterone levels. Further investigation identified and removed a 9-mm adenoma in the left adrenal gland, yet testosterone levels remained high. Subsequent tests ruled out adrenal gland pathology. Ultimately, treatment with nafarelin, a gonadotropin-suppressing agent, significantly reduced testosterone levels and improved clinical symptoms. The study concluded that the patient likely had residual testosterone-producing tissue, sensitive to gonadotropins, from primitive mesenchymal cells in an unidentified location in the abdomen or pelvis.