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[Iatrogenic androgenization]

R Mangold1, V Heilmann, W G Rossmanith

  • 1Universitäts-Frauenklinik Ulm. Raphael.Mangold@medizin.uni-ulm.de

Zentralblatt Fur Gynakologie
|November 21, 1998
PubMed
Summary

Postmenopausal virilization can stem from tumors or unrecognized topical testosterone cream use. This case highlights iatrogenic androgenization as a crucial differential diagnosis.

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Area of Science:

  • Endocrinology
  • Gynecology

Background:

  • Virilization in postmenopausal women typically raises suspicion for androgen-secreting adrenal or ovarian tumors.
  • However, iatrogenic causes of androgen excess must also be considered in the differential diagnosis.

Observation:

  • A 64-year-old woman presented with progressive signs of virilization.
  • Initial investigations excluded an adrenal source, and the patient denied using any androgenic medications.
  • Elevated serum testosterone levels suggested ovarian hyperandrogenism, prompting planned surgical exploration.

Findings:

  • A diagnosis of extensive vulvar lichen sclerosus was made.
  • This finding suggested potential long-term use of topical testosterone creams for symptom relief.
  • The patient did not initially recognize topical application as medication use.

Implications:

  • This case underscores the importance of considering iatrogenic androgenization, particularly from unrecognized topical applications.
  • It highlights the need for thorough patient history regarding all substance use, including over-the-counter or self-prescribed treatments.
  • Clinicians should maintain a broad differential diagnosis for virilization in postmenopausal women.

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