Virilization in a Postmenopausal Woman: Ovarian Leydig Cell Tumor

A 70-year-old postmenopausal woman presented with rapid onset virilization symptoms, including male pattern hair loss and increased body hair growth. Despite treatment with flutamide, her symptoms did not improve. Laboratory tests revealed elevated testosterone levels with normal DHEAS, and imaging did not show any abnormalities in the adrenal glands or ovaries. However, after a bilateral laparoscopic salpingo-oophorectomy, she was diagnosed with a right ovarian Leydig cell tumor, a rare tumor accounting for less than 0.1% of all ovarian tumors. Postoperatively, her serum testosterone levels normalized, and her body hair began to decrease. This case highlights the challenge of diagnosing hyperandrogenism in postmenopausal women and the importance of considering ovarian Leydig cell tumors as a potential cause, despite their rarity and difficulty to detect through imaging.