Ovarian Hyperthecosis Presenting as Polycythemia

A 58-year-old postmenopausal woman presented with polycythemia on routine laboratory examinations along with long-standing hirsutism. The objective of this report is to highlight polycythemia as a rare presenting feature of ovarian hyperthecosis (OH).

A 58-year-old woman presented with elevated hemoglobin and hematocrit levels in the primary care setting on routine laboratory examinations. On further workup, she was found to have elevated testosterone levels. Further history was relevant for excessive facial hair, frontal hair loss, and deepened voice. Examination findings were consistent with significant hirsutism. Adrenal and ovarian imaging was negative for tumor. The patient elected to have laparoscopic bilateral oophorectomy, which revealed OH on surgical pathology. After 2 months of surgery, the total testosterone levels became normal, and polycythemia resolved.

In a postmenopausal woman, hirsutism with virilization should generally prompt urgent investigation because these signs are associated with malignant androgen-secreting tumors of the adrenal gland and ovaries. However, these symptoms can also be the result of benign causes such as OH.

This case is a rare illustration of OH in a postmenopausal woman presenting with polycythemia secondary to severe hyperandrogenism. Suspicion for this condition is crucial in evaluation for rare causes of polycythemia because if left untreated, it can lead to increased morbidity and mortality.