Postmenopausal Occult Ovarian Disease With Hirsutism – A 6-Year Follow-up Course

A postmenopausal woman presented with long-standing androgenic alopecia and progressive hirsutism. Despite normal imaging, markedly elevated testosterone levels (18.58 nmol/L) prompted surgical exploration. Bilateral salpingo-oophorectomy revealed a Leydig cell tumor, confirmed histologically by Reinke crystals. Postoperative hormonal normalization and clinical improvement affirmed the ovarian origin. This case underscores the diagnostic challenge of occult androgen-secreting tumors in postmenopausal women, especially when imaging is inconclusive. It highlights the need for high clinical suspicion and thorough evaluation in cases of virilization, emphasizing that Leydig cell tumors, though rare, remain a critical differential in postmenopausal hyperandrogenism.