MON-LB044 Bilateral Ovarian Hyperthecosis: A Benign and Unusual Cause of Postmenopausal Hirsutism

Abstract

Abstract Introduction-: Postmenopausal hirsutism is a rare presentation. The presentation of clinical hyperandrogenism , its severity and the pace of presentation along with the hormonal profiles help in determining the cause. Once iatrogenic cause is ruled out, one has to assess for the endocrine causes of postmenopausal hirsutism. There are various benign and malignant causes of ovarian hyperandrogenism. Case Presentation- A 62 years post menopausal lady came with complaints of increasing facial hair, coarseness of facial skin and alopecia for two years. She had no significant medical illness and had not received androgens in any form. She had a normal menstrual history during her reproductive years and has two children born of natural conception. Clinically there was no evidence of other endocrine causes of hyperandrogenism like Acromegaly, Cushing’s syndrome, Late onset CAH. Her hormonal profile showed significantly elevated testosterone levels with normal DHEAS levels. Investigations - TSH 1.898 uIu/ml (NR 0.5-5.0); Testosterone 216.10 ng/dl ( NR 20-90); DHEAS 40 mcg/dl ( NR 17-90); USG abdomen and pelvis showed thickened endometrium 8 mms in size and submucosal fibroid. Further investigations-Serum Testosterone 145 ng/dl (NR 20-90); DHEAS 23.8 mcg/dl ( NR 17-90); 17 OH Progesterone 0.86 ng/ml ( NR 0.2- 0.5); Post Dexamthasone 1 mg cortisol < 1.0 mcg/dl (normal response< 1.8- 2.0); Alpha Fetoprotein 2.08 ng/ml ( NR <10 ng); IGF1 71 ng/ml ( NR 70-140) ; Estradiol 10 pg/ml ( NR <30). Her assessment for other causes of hirsutism ruled out Acromegaly, Late onset CAH and Cushing syndrome. MRI abdomen and pelvis revealed normal ovaries and uterus for her menopausal status. In view of persistent symptoms and very high levels of testosterone along with endometrial hyperplasia, patient was counselled to get her ovaries and uterus removed.She underwent a total hysterectomy with bilateral oophorectomy. Postoperatively the patients symptoms have improved, her skin hue is better and the facial hair growth has significantly reduced. The testosterone levels have returned to normal. Postoperative Total Testosterone 16.12 ng/dl ( NR 20-90) and Free Testosterone 1.63pg/ml ( NR 0.3-2). The histopathology showed bilateral ovarian hyperthecosis along with benign endometrial hyperplasia. Conclusion: Polycystic ovaries is a common cause of hirsutism in young women of reproductive age group. It is not commonly seen in the post menopausal state. Even though the hormonal profile points towards an ovarian cause, localisation of an ovarian pathology is sometimes difficult. Diagnostic and therapeutic bilateral oophorectomy points towards the diagnosis which can be unusual and curable like bilateral ovarian hyperthecosis. This was an unusual , curable and rewarding case of postmenopausal hirsutism. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.