Severe Hyperandrogenism in a Premenopausal Woman With an Imaging-Negative Leydig Cell Tumor

The document described a case of severe hyperandrogenism in a 42-year-old premenopausal woman with a history of polycystic ovarian syndrome (PCOS), who presented with symptoms such as frontal alopecia, voice deepening, and coarse facial hair. Despite multiple imaging tests showing no abnormalities, her testosterone levels were significantly elevated. The diagnosis was confirmed after an oophorectomy revealed a 1.8-cm Leydig cell tumor (LCT). This case highlighted the challenges in diagnosing small, androgen-producing ovarian tumors that may not be detected through imaging and underscored the importance of considering ovarian tumors in hyperandrogenic women when other causes are excluded. Post-surgery, her testosterone levels normalized.