Virilizing Ovarian Tumor in a Woman with an Adrenal Nodule

In 2010, a 41-year-old woman with a history of amenorrhea and virilization symptoms was diagnosed with a Leydig cell tumor, a type of androgen-secreting neoplasm (ASN), in her right ovary, despite initial normal ovarian findings and the presence of an adrenal nodule on a CT scan. Elevated serum testosterone levels pointed to an ovarian tumor, which was confirmed by Doppler transvaginal ultrasound and histopathology. After surgical removal of the tumor, her testosterone levels normalized within 3 days. The case underscores the necessity of comprehensive clinical and biochemical evaluations to accurately diagnose rare ASNs and the effectiveness of transvaginal ultrasound with Doppler for tumor identification. It also highlights the importance of considering ovarian sources for androgen secretion even when adrenal nodules are detected, as well as the significant metabolic implications of hyperandrogenism, including increased cardiovascular risk. The patient was diagnosed with stage IIIC ovarian cancer and started adjuvant chemotherapy.