SUN-100 A Case of Exogenous Androgen Exposure Mimicking an Ovarian Tumor

Abstract Disclosure: M. Tsikala Vafea: None. A.E. Dunaif: None. Determining the source of testosterone in the tumor range (greater than 150 ng/dL with a liquid chromatography-tandem mass spectrometry [LC-MS/MS] assay) can be challenging. We present a case of a 47-year-old G3P2 premenopausal woman with recent onset of true virilization. Menses were regular until age 44 when she started experiencing irregular menses every 5-52 weeks. She also noted increased terminal hair growth on the sideburns, chin, back, chest, upper abdomen, and arms, skin erythema, voice changes, hot flashes, and increased muscle mass. She was not on any medications but was taking a multivitamin. She was consuming protein shakes. She denied any testosterone or anabolic steroid use. Initial testing showed markedly elevated total testosterone 385 ng/dL (<50), FSH 1.2 mIU/mL, undetectable LH <0.3 mIU/mL, and low SHBG 6.6 nmol/L (24.6-122.0) and androstenedione 16 ng/dL (28-230) levels. DHEAS 84 ug/dL (41.2-243.7) levels were in the normal range. Screening for Cushing Syndrome by dexamethasone suppression test was negative. Imaging, including MRI and transvaginal ultrasound, revealed no ovarian or adrenal masses. She was referred for oophorectomy for a suspected ovarian androgen-secreting tumor. Repeat testing showed testosterone levels that fluctuated between the low/normal and the tumor range 2-576 ng/dL, raising concern for exogenous androgen exposure. Further evaluation revealed undetectable testosterone <2.5 ng/dL (10-55) and androstenedione <10 ng/dL (28-230) levels by LC-MS/MS, suppressed SHBG 5.0 nmol/L (24.6-122.0) and gonadotropin (LH and FSH <0.3 mIU/mL) levels. Urine screening was positive for stanozolol. The patient’s husband was receiving injectable testosterone for hypogonadism. Despite discontinuing supplements and protein shakes, urine stanozolol remained detectable after one month. However, gonadotropin (LH 2.6 and FSH 3.7 mIU/mL), SHBG (7.0 nmol/L) and total testosterone levels (2.8 ng/dL LC-MS/MS) were increased, suggesting recovery of the hypothalamic-pituitary-gonadal axis as stanozolol was cleared. Stanozolol can be detectable in the urine for up to 28 days after ingestion. This case underscores the importance of considering exogenous androgen use in virilization, particularly with suppressed testosterone and SHBG levels. A thorough medication and social history, including partner medication use and urine drug screening, are essential for accurate diagnosis and to prevent unnecessary surgical interventions. Stanozolol, a potent orally active synthetic androgen, can be found in contaminated supplements, emphasizing the need to consider urine screening for anabolic steroids when evaluating women with unexplained virilization. Presentation: Sunday, July 13, 2025