Marked hyperandrogenicity in a 60-year-old woman

<jats:p>Markedly elevated androgen levels can lead to clinical virilization in females. Clinical features of virilization in a female patient, in association with biochemical hyperandrogenism, should prompt a search for an androgen-producing tumor, especially of ovarian or adrenal origin. We herein report the case of a 60-year-old woman of Pakistani origin who presented with the incidental finding of male pattern baldness and hirsutism. Her serum testosterone level was markedly elevated at 21 nmol/L (normal range: 0.4–1.7 nmol/L), while her DHEAS level was normal, indicating a likely ovarian source of her elevated testosterone. Subsequently, a CT abdomen-pelvis was performed, which revealed a bulky right ovary, confirmed on MRI of the pelvis as an enlarged right ovary, measuring 2.9 × 2.2 cm transaxially. A laparoscopic bilateral salpingo-oophorectomy was performed, and histopathological examination and immunohistochemistry confirmed the diagnosis of a Leydig cell tumor, a rare tumor accounting for 0.1% of ovarian tumors. Surgical resection led to normalization of testosterone levels.</jats:p> <jats:sec> <jats:title>Learning points:</jats:title> <jats:list list-type="bullet"> <jats:list-item> <jats:p>Hirsutism in postmenopausal women should trigger suspicion of androgen-secreting tumor</jats:p> </jats:list-item> <jats:list-item> <jats:p>Extremely elevated testosterone level plus normal DHEAS level point toward ovarian source</jats:p> </jats:list-item> <jats:list-item> <jats:p>Leydig cell tumor is extremely rare cause of hyperandrogenicity</jats:p> </jats:list-item> </jats:list> </jats:sec>