Virilising ovarian tumour in a woman with an adrenal nodule

Androgen secreting tumours are the least commonly encountered androgen excess disorders, having a prevalence of 0.2%. Androblastomas of the ovary comprise less than 0.5% of all ovarian tumours. Pure Leydig cell tumours are very rare and almost always show secretion of male sex hormones. A 41-year-old multipara Filipino woman presented with a 2-year history of amenorrhoea and virilisation characterised by hirsutism, androgenic alopecia, masculine habitus and clitoromegaly. Diagnostic evaluation showed markedly elevated serum testosterone and normal dehydroepiandrosterone sulfate. Normal ovaries were seen on initial transvaginal ultrasound. A low dose dexamethasone suppression test suggested an ovarian source. A left adrenal nodule was seen on CT scan. Doppler transvaginal ultrasound revealed a solid lobulated structure in the right ovary. The patient underwent surgery and histopathology showed a Leydig cell tumour, hilar type. Serum testosterone levels normalised 3 days after surgery. Specific clinical and biochemical investigation of androgen secreting neoplasms is very important for correct diagnosis of these rare tumours.