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
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    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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