O-11 Diagnostic Challenges in Postmenopausal Hyperandrogenism: Reports of Two Cases

Abstract Introduction Postmenopausal hyperandrogenism is rare but clinically important. The differential diagnosis includes androgen-secreting ovarian or adrenal tumors, and benign conditions such as ovarian hyperthecosis and stromal hyperplasia. Hyperandrogenemia is easily detected in laboratory tests, but identifying its source may be difficult. In ovarian hyperthecosis, the ovaries produce excess androgens without a discrete lesion, making surgery both diagnostic and therapeutic. We present two postmenopausal women with hirsutism and alopecia, underscoring the need for clinical, biochemical, radiological, and histopathological correlation. Clinical Case 1 A 50-year-old woman (G4A0P4) with a history of type 2 diabetes, hypertension, and hyperlipidemia presented with a one-year history of progressive facial, truncal, and limb hirsutism, as well as alopecia. Menopause occurred at age 46. Physical examination revealed androgenic alopecia and generalized hypertrichosis, with a Ferriman–Gallwey (FG) score of 16. Laboratory tests showed menopausal gonadotropin levels with elevated total testosterone (see Table 1). Bilateral ovarian enlargement with increased parenchymal echogenicity was observed on TVUS and abdominal MRI (right ovary: 42×23 mm; left ovary: 43×18 mm). Tumor markers CA 15-3 and CA 19-9 were mildly elevated. Bilateral salpingo-oophorectomy was performed, and histopathology revealed ovarian stromal hyperplasia/hyperthecosis. At six months, alopecia regressed and the FG score decreased to 8. Total testosterone and tumor markers were normalized (see Table 1). Clinical Case 2 A 49-year-old woman (G2A0P2) with no prior history had 3–4 months of progressive hirsutism, alopecia, and voice deepening. Menopause occurred at age 46. Examination showed androgenic alopecia and generalized hypertrichosis, with an FG score of 17. Laboratory evaluation showed menopausal gonadotropin levels with high testosterone (see Table 1). Gynecologic examination revealed a leiomyoma; the ovaries were age appropriate. Abdominal CT revealed no mass. Oophorectomy was performed, and hysterectomy was added owing to concomitant cervical dysplasia. Histology showed CIN-1, chronic cervicitis, adenomyosis, leiomyoma, and a luteal cyst; the ovaries were normal. At one year, alopecia and hypertrichosis had resolved, the FG score had fallen to 6, and testosterone had normalized (see Table 1). Conclusion These cases highlight the diagnostic challenges of postmenopausal hyperandrogenism. Severe androgen excess with virilizing features typically raises concern for an androgen-secreting tumor; however, benign entities such as ovarian hyperthecosis or stromal hyperplasia may present with a similar clinical picture. When no discrete mass is identified, definitive diagnosis often relies on histopathological evaluation following surgery. Recognizing these benign but clinically significant conditions is essential to avoid misdiagnosis, to prevent unnecessary patient anxiety, and to ensure appropriate management.Table 1:Laboratory findings of the patients pre- and postoperatively