Ovarian Hyperthecosis Presenting With Postmenopausal Virilization and New-Onset Type 2 Diabetes

Postmenopausal virilization accompanied by insulin resistance is rare and may present as a diagnostic challenge. Ovarian hyperthecosis is characterized by ovarian stromal cell proliferation, leading to androgen excess and associated insulin resistance. Here, we present a case of a 58-year-old postmenopausal woman with new onset virilization and associated type 2 diabetes due to ovarian hyperthecosis, who was successfully treated with bilateral oophorectomy, resulting in normalization of hyperandrogenism and improvement in glycemic control along with metformin and lifestyle advice. This case underscores the importance of recognizing ovarian hyperthecosis as a differential diagnosis when assessing new onset virilization and metabolic disturbance in postmenopausal women.