Postmenopausal Virilization Due to a Rare Left Ovarian Androgen-Secreting Leydig Cell Tumor Identified by Ovarian Vein Sampling

A 57-year-old postmenopausal woman presented with a 10-year history of hirsutism and a 4-year history of virilization, including voice deepening, excessive hair growth, male pattern baldness, and clitoromegaly. Her total testosterone levels were significantly elevated at 11.5nmol/L, while other hormonal tests were normal. Imaging studies failed to identify any adrenal or ovarian masses. However, ovarian vein sampling indicated a strong lateralization to the left ovary, with a total testosterone level of 780nmol/L. Subsequent bilateral salpingo-oophorectomy revealed a rare left ovarian Leydig cell tumor, which was the source of the androgen secretion. Post-operatively, the patient's testosterone levels normalized, and her virilizing symptoms improved. This case underscores the importance of considering rare androgen-secreting ovarian tumors in postmenopausal virilization and the utility of ovarian vein sampling for tumor localization when imaging is inconclusive.