Indication for diagnostic oophorectomy without radiographic evidence: two cases of postmenopausal androgen-secreting ovarian hyperplasia.

Objectives: Hyperandrogenism, while one of the most common endocrine disorders in women, is relatively uncommon in the postmenopausal population. When present, it may be indicative of an underlying rare androgen-secreting ovarian tumor. Here, we report 2 cases: a 63-year-old woman with 2 years of male-pattern baldness and hirsutism and a 71-year-old female with 2 years of progression to complete scalp alopecia, hirsutism, and libido changes.

Methods: Upon endocrine evaluation, testosterone concentrations were markedly elevated for both patients. In the first case, there was no radiologic evidence of ovarian mass on ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). In the second case, transvaginal ultrasound (TVUS) detected an ovarian lesion, which guided further radiologic workup; however, positron emission tomography (PET) and MRI were unremarkable.

Results: In case 1, surgical pathology upon total hysterectomy with bilateral salpingo-oophorectomy revealed bilateral Leydig cell hyperplasia. For case 2, surgical intervention revealed a right ovarian steroid cell tumor with contralateral stromal and hilus cell hyperplasia.

Conclusion: In both patients, testosterone levels normalized immediately following total hysterectomy with bilateral salpingo-oophorectomy. In conjunction, these 2 cases highlight the importance of having a high clinical suspicion for steroid cell tumors or hyperplasia in postmenopausal women presenting with features of hyperandrogenism and elevated testosterone levels despite unrevealing radiographic findings.