MON-336 Ovaries Reveal Their Inner Testes

Introduction Hyperandrogensim is a very common endocrinopathy in the women of reproductive age group. However, this condition is uncommon after menopause and warrants a diligent evaluation for rarer neoplastic causes. Clinical Case A 48 year old woman without pertinent endocrine history presented with facial acne, baldness, hirsutism, deepening of voice & amenorrhea progressively worsening over 5 years . On examination, she was found to have Ferriman-Gallwey score of 8, androgenic alopecia and clitorimegaly . She denied use of exogenous testosterone and there were no obvious stigmata of Cushing's syndrome, congenital adrenal hyperplasia or acromegaly. She denied using medications with potential to cause hyperandrogensim. Her Total Testosterone levels were persistently elevated at 528-1084 ng/dl (14-76 ng/dl), bioavailable Testosterone levels were also elevated at 240-126ng/dl (3.2-34.6ng/dl). SHBG was normal at 37.9nmol/L (14-73nmol/L) with abnormally high free Testosterone at 64.8pg/ml (0.1-6.4pg/ml). DHEA-S levels were normal at 214mcg/dl (19-231 mcg/dl), with normal 17-OH progesterone, FSH, LH, prolactin and 24 hour urine cortisol levels. She underwent CT scan of the abdomen and pelvis that demonstrated normal adrenal glands and ovaries. Subsequently, simultaneous adrenal and ovarian vein sampling showed high total testosterone levels from bilateral gonadal veins. Transvaginal ultrasound revealed right hyperthecosis. Ultimately, she underwent laparoscopic hysterectomy with bilateral oophorectomy and final pathology was consistent with 2.1cm left Leydig cell tumor and a normal right ovary. Postoperatively patient total testosterone levels normalized to 15ng/dl (14-76ng/dl ) with resolution of acne, hirsutism and virilization. Conclusion Tumorous hyperandrogenism is a very rare entity and is associated with rapid onset of virilization. Androgen secreting ovarian tumors are mostly benign and account for <0.5% of ovarian neoplasms. Our case emphasizes the need for careful evaluation with a high index of suspicion for this uncommon condition and highlights the limitation of ovarian venous sampling for androgen measurement given the long half life of testosterone .