Granulosa cell tumor resection with subsequent onset of rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disorder with an estrogen correlation. The disease can worsen or present with menopause. Granulosa cell tumors (GCT) are estrogen-secreting ovarian sex-cord stromal tumors with median incidence in the early postmenopausal years. We report a 38-year-old female who presented with a 20 cm pelvic mass and elevated inhibin and underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy for a Stage I GCT. She developed progressive post-operative joint pain and weakness before an eventual diagnosis of seropositive RA. With tumor resection and surgical menopause, the patient experienced an abrupt decline in estrogen levels precipitating the onset of RA symptoms. Prior research identified that hormone fluctuation at menopause correlates with onset of RA. While unfortunately direct estrogen measurements were not obtained perioperatively, this case does support circumstantial evidence correlating RA with menopause and a decline in estrogen, irrespective of age.