PMON225 Androgen excess in pre-menopausal women due to Granulosa Cell tumor: A case report.

A 23-year-old nulliparous female without any significant past medical history presented for irregular menstrual cycles, amenorrhea, hirsutism and 25-pound weight loss in one year. Excessive hair growth was found on the face and chest. Prior to endocrinology visit she was started on oral contraceptives without any improvements. Of importance, she had a negative progesterone challenge test (no withdrawal bleeding). On examination in the Endocrinology clinic, she was a class II morbidly obese female, with coarse terminal hair on her chin and chest and no cushingoid features. Intra-vaginal ultrasound revealed large bilateral multi cystic masses in the ovaries. Her laboratory work up was significant for elevated DHEA-S at 826.6 ng/dl (134-407), Total testosterone 144 ng/dl(0-60) and free testosterone 4.75 ng/dl (0.06-1.08). Her 17-OH pregnenolone was also elevated at 539 ng/dl (31- 455), Inhibin B was elevated at 374 pg/ml (<139 premenopausal). 17 - OH progesterone was normal. Estradiol, inhibin A and FSH/LH were normal. ACTH, AM cortisol, TSH and prolactin were normal. Beta HCG and Cancer markers CA 19-9, CA 125, and CEA were negative. CT scan of the abdomen showed a right ovarian mass measuring 10.7×9.6×9.2 cm. Adrenal glands were normal. Patient subsequently underwent a laparoscopic diagnostic right salpingo-oophorectomy. Pathology was reported as an adult granulosa cell tumor (9.5 cm) of the ovary with an intact capsule. After surgery Inhibin B level decreased from 374 to 10 (normal <139), Total testosterone decreased from 144 to 36 ng/dl (0-60), Free testosterone decreased from 4.75 to 1.22 ng/dl (0.06-1.08) and DHEA-S from 826.60 to 687.40 ng/dl (134-407) however remained elevated. Moreover, after surgery irregular menses resolved and she noted some improvement in hirsutism. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.