Postmenopausal Virilization: Rare Case of an Ovarian Tumor Not Easily Identified on Imaging

In 2020, a case study was conducted on a 58-year-old post-menopausal woman who presented with virilization symptoms such as deepening of voice, male pattern hair loss, increased muscle mass, weight gain, clitoromegaly, acne, and increased axillary & facial hair growth over a period of 1.5 years. Initial tests revealed a significantly elevated testosterone level of 630 ng/dL (normal range 2-45ng/dL). Despite the absence of a definitive source of elevated androgens, a CT scan showed bilateral adrenal adenomas. However, these were considered less likely to be the cause of her virilization. A hysterectomy was recommended due to concerns of an ovarian malignancy. Post-operatively, the patient's testosterone levels fell drastically to 18 ng/dL and she reported new scalp hair growth, decreased abdominal girth & skin smoothing. The surgical pathology was consistent with a steroid tumor of the ovary. The study concluded that in the presence of elevated testosterone levels or virilizing symptoms, an ovarian etiology must be suspected. Timely management of the tumor can reduce metastasis and significantly improve quality of life.