Clinical Case Seminar: Postmenopausal Androgen Excess - Challenges in Diagnostic Work-Up and Management of Ovarian Thecosis

October 2017 in “ Clinical Endocrinology ”

Yaasir Mamoojee, Murali Ganguri, Norman Burke Taylor, Richard Quinton

postmenopausal hyperandrogenism hirsutism androgenic alopecia serum testosterone GnRH suppression test spironolactone bilateral salpingo-oophorectomies ovarian hyperthecosis virilizing ovarian tumors low-dose dexamethasone suppression test steroid metabolomic profiling insulin resistance testosterone GnRH test ovarian tumors dexamethasone test steroid profiling

TLDR The conclusion is that removing both ovaries is the best treatment for excess male hormones in postmenopausal women, with medication as another option, and managing insulin resistance is important for diagnosis and treatment.

The document presented a case of a 72-year-old woman with postmenopausal hyperandrogenism, characterized by hirsutism, androgenic alopecia, and voice deepening. Elevated serum testosterone levels and imaging suggested a benign ovarian cause, which was confirmed by a GnRH suppression test. The patient was treated with spironolactone and later underwent bilateral salpingo-oophorectomies, resulting in normalized hormonal profiles and improved hirsutism. The document highlighted the diagnostic challenges in distinguishing between ovarian hyperthecosis (OH) and virilizing ovarian tumors (VOTs), noting that while certain tests can identify the source of androgen excess, they cannot reliably differentiate between OH and VOTs. It also discussed the limitations of the low-dose dexamethasone suppression test in insulin-resistant women and the potential of steroid metabolomic profiling as a future diagnostic tool. The document concluded that bilateral laparoscopic salpingo-oophorectomy is the preferred treatment for postmenopausal hyperandrogenism, with medical therapy as an alternative or interim measure, and emphasized the importance of addressing insulin resistance for diagnostic and therapeutic purposes.

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Research cited in this study

6 / 6 results

Discriminating Between Virilizing Ovary Tumors and Ovary Hyperthecosis in Postmenopausal Women: Clinical Data, Hormonal Profiles, and Imaging Studies

research Discriminating Between Virilizing Ovary Tumors and Ovary Hyperthecosis in Postmenopausal Women: Clinical Data, Hormonal Profiles, and Imaging Studies

27 citations, April 2017 in “European journal of endocrinology”

The research found that MRI and certain hormone levels can help tell apart ovarian tumors from hyperthecosis in postmenopausal women, but tissue analysis is still needed for a definite diagnosis.

research Management of Endocrine Disease: Hyperandrogenism After Menopause

84 citations, September 2014 in “European journal of endocrinology”

Doctors should check for serious tumor causes of high androgen levels in postmenopausal women and more research is needed on this condition.

Risk of Meningioma Among Users of High Doses of Cyproterone Acetate Compared With the General Population: Evidence From a Population-Based Cohort Study

research Risk of Meningioma Among Users of High Doses of Cyproterone Acetate Compared With the General Population: Evidence From a Population-Based Cohort Study

88 citations, May 2011 in “British Journal of Clinical Pharmacology”

High doses of cyproterone acetate are linked to an increased risk of developing meningioma.

The Investigation and Management of Severe Hyperandrogenism Pre- and Postmenopause: Non-Tumor Disease Is Strongly Associated with Metabolic Syndrome and Typically Responds to Insulin-Sensitization with Metformin

research The Investigation and Management of Severe Hyperandrogenism Pre- and Postmenopause: Non-Tumor Disease Is Strongly Associated with Metabolic Syndrome and Typically Responds to Insulin-Sensitization with Metformin

14 citations, January 2008 in “Gynecological Endocrinology”

High levels of male hormones in women without tumors are linked to metabolic problems and can be treated with metformin.

research Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome (PCOS)

4025 citations, December 2003 in “Human Reproduction”

The 2003 consensus updated PCOS diagnosis criteria and linked PCOS to higher risks of diabetes and heart problems, recommending lifestyle changes to lower these risks.

A Prospective Study of the Prevalence of Clear-Cut Endocrine Disorders and Polycystic Ovaries in 350 Patients Presenting with Hirsutism or Androgenic Alopecia

research A Prospective Study of the Prevalence of Clear-Cut Endocrine Disorders and Polycystic Ovaries in 350 Patients Presenting with Hirsutism or Androgenic Alopecia

135 citations, August 1994 in “Clinical Endocrinology”

Most women with hirsutism or androgenic alopecia had polycystic ovaries, especially if they had irregular periods.

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research Discriminating Between Virilizing Ovary Tumors and Ovary Hyperthecosis in Postmenopausal Women: Clinical Data, Hormonal Profiles, and Imaging Studies

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The research found that MRI and certain hormone levels can help tell apart ovarian tumors from hyperthecosis in postmenopausal women, but tissue analysis is still needed for a definite diagnosis.

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Postmenopausal hyperandrogenism, a condition with symptoms like increased hair growth and acne, is usually caused by PCOS but can also be due to other factors. It's diagnosed by checking testosterone levels and treated either by removing the adrenal tumor or through antiandrogen therapy.

research The Investigation and Management of Severe Hyperandrogenism Pre- and Postmenopause: Non-Tumor Disease Is Strongly Associated with Metabolic Syndrome and Typically Responds to Insulin-Sensitization with Metformin

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