An Interesting Cause of Hyperandrogenemic Hirsutism

Abstract

Mild clinical signs of hyperandrogenism such as hirsutism may appear during the menopausal transition as part of the normal aging process, but the development of frank virilization suggests a specific source of androgen excess. We report a case of a 68-year-old woman with signs of virilization that had started 6 months before. Clinical analyses revealed high levels of serum testosterone for a postmenopausal woman. Pelvic MRI and abdomen CT showed no evidence of ovarian and adrenal tumor. Postmenopausal hyperandrogenism can be the result of numerous etiologies ranging from normal physiologic changes to ovarian or rarely adrenal tumors. Our patient was found to have iatrogenic hyperandrogenism. This condition is rarely reported cause of virilization.

A case of postmenopausal androgen excess

“…Hirsutism can be found in approximately 50% of patients with CS mainly attributed to adrenal androgen excess; endogenous hypercortisolism also correlates positively with free androgen levels probably due to SHBG reduction [2,6]. In our case, there was no adrenal mass in the adrenal CT, serum cortisol was normally suppressed after a 1-mg overnight dexamethasone suppression test and urinary free cortisol levels were into a normal range, excluding the possibility of hypercortisolism.…”

“…Drugs most commonly responsible include androgens, anabolic steroids, and antiepileptics [6]. A study on the effect of levetiracetam (LEV) on steroidogenesis in forskolin-stimulated H295R cells showed that LEV exposure apparently had a minimal effect on hormone secretion that could be considered as biologically significant.…”

“…After menopause, a magnification of the standard morphologic characteristics of the ovaries' stroma occurs as a response to the elevated gonadotropin levels [6]. This situation is more and frequently compatible with hyperthecosis and leads to androgen excess from the stromal cells.…”

“…Tumorous hyperandrogenism is suspected when testosterone levels are greater than 100-145 ng/dl and is usually associated with abrupt onset and rapid progression of signs of virilization [6]. Adrenal androgen-secreting tumors are rare but highly suggestive of malignancy.…”

Hyperandrogenism in a Postmenopausal Woman Secondary to Testosterone Secreting Ovarian Stromal Tumor with Acoustic Schwannoma

“…Clinical manifestations of hyperandrogenism include hirsutism, alopecia, acne, virilization, and emotional distress [1]. Common causes of hyperandrogenism are polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia (CAH), Cushing's syndrome, and ovarian tumors [2]. At reproductive age, PCOS is considered the most frequent cause of high androgens in females [2].…”