SUN-106 Nonsurgical Management of Hyperandrogenism in a Postmenopausal Woman

Abstract Disclosure: E. Krishnaraju: None. F. Meah: None. Introduction: Ovarian hyperthecosis is a rare but important differential for hyperandrogenism in postmenopausal women. We report a case of hyperandrogenism of presumed ovarian origin successfully treated with medical management. Clinical Case: A 68-year-old African American female presents for evaluation of hypertension and hypokalemia diagnosed twenty years prior. Secondary evaluation was concerning for primary aldosteronism, but no adrenal tumor was detected on imaging. Spironolactone therapy was not tolerated due to dizziness. One year later, she complained of increased hair growth on her chin and a deeper voice for three years. Physical exam was notable for a masculine voice, terminal hair growth on the chin, and normal external genitalia. Labs revealed an elevation of total (134ng/dL) and free (12 pg/mL) testosterone with unremarkable DHEA-S, 17-hydroxyprogesterone, and 11 pm salivary cortisol levels. CT abdomen with adrenal imaging showed trace bilateral adrenal thickening that was stable for six years. Pelvic ultrasound showed the right ovary measuring 1.4 x 1.6 x 1.7 cm and the left ovary measuring 1.1 x 1.5 x 2.5 cm with incidental uterine fibroids. MRI of the pelvis did not show any obvious adnexal lesions but had limited evaluation due to motion artifacts. She was referred for bilateral salpingo-oophorectomy due to a suspected ovarian source, however was deemed a poor surgical candidate given her history of recurrent ventral hernia repairs and the risk of bowel perforation. The patient chose to proceed with Goserelin 3.6mg SC injections monthly for six months with subsequent normalization of her testosterone levels, decrease in hirsutism, and improvement in blood pressure(BP). Two years later, she presented with labile BP. Labs were concerning for hyperaldosteronism with a high total (63ng/dL) and free (6pg/mL) testosterone, unremarkable DHEA-S, and unchanged ovarian and adrenal imaging. The patient declined surgery due to the risks and restarted Goserelin 3.6mg SC with normalization of testosterone levels and decreased BP lability within two months. Conclusion: This patient's good response to GnRH agonist therapy makes a tumoral source less likely, however the true source- ovarian or adrenal- remains unclear. Bilateral oophorectomy is the gold standard for diagnosis and treatment of ovarian secretion of androgens due to both benign and malignant causes. GnRH agonists are a useful alternative in controlling symptomatology and normalizing testosterone levels in those who are not surgical candidates. Presentation: Sunday, July 13, 2025