A rare cause of postmenopausal hyperandrogenism

Area of Science:

• Endocrinology
• Gynecologic Oncology
• Pathology

Background:

• Postmenopausal hyperandrogenism presents a diagnostic challenge, often necessitating investigation for hormone-secreting ovarian neoplasms.
• Ovarian neoplasms are typically sex cord stromal tumors, but less common causes like mucinous cystadenoma must be considered.

Observation:

• A 71-year-old postmenopausal woman presented with rapidly progressive virilization, including androgenic alopecia and clitoromegaly.
• Elevated serum testosterone levels and a 4x4 cm ovarian cystic mass were identified via MRI.
• Histopathology confirmed a mucinous cystadenoma after bilateral salpingo-oophorectomy.

Findings:

• The mucinous cystadenoma was identified as the cause of severe hyperandrogenism and virilization in this postmenopausal patient.
• Postoperative normalization of testosterone levels (<0.4 µg/L) confirmed the tumor's hormone-secreting nature.
• This case represents the sixth documented instance of mucinous adenoma-induced virilization in postmenopausal women.

Implications:

• Ovarian mucinous cystadenoma, typically considered non-functional, can manifest as a cause of severe, rapidly progressive hyperandrogenism in postmenopausal women.
• Early recognition and surgical resection are crucial for managing this rare condition.
• This finding expands the differential diagnosis for postmenopausal hyperandrogenism, emphasizing the need to consider less common ovarian tumors.