SUN-104 Ovarian Stromal Hyperplasia: A Rare Cause of Hyperandrogenism in a 59-Year-Old Female With Treatment Related Menopause and Normal Imaging Findings

Abstract Disclosure: D. Lee: None. N. Pham: None. Background: Ovarian stromal hyperplasia (OSH) is a known but rare disorder that can lead to hyperandrogenism in postmenopausal females. Due to its rarity and diagnostic challenges, OSH is frequently overlooked which may lead to treatment delay. The etiology of OSH is also not completely understood. We present a case of OSH in a patient with treatment related menopause that was only diagnosed after thorough biochemical confirmatory testing and surgical management. Clinical case: Our patient is a 59-year-old female with a history of triple negative breast cancer (TNBC) who began developing symptoms of hyperandrogenism for the last 2 years. Specifically, she described excess hair growth, increased weight gain, and deepening of the voice. Her treatment for TNBC involved neoadjuvant chemotherapy with doxorubicin, cyclophosphamide, and paclitaxel, anastrozole, and Xeloda which resulted in treatment related menopause. On physical exam, she had vertex hair loss, acanthosis, and increased hair to the arms, dorsal hands, and face. Initial lab work was notable for Total Testosterone level of 195 (normal 8-60 ng/dL) and free Testosterone 4.36 (normal <0.13-0.90 ng/dL) with a DHEA-S 152 (normal 16-195 mcg/dL). MRI and Ultrasound of the pelvis interestingly had no major abnormalities of the ovaries and adrenal glands. Because of the normal imaging findings, a 3-day dexamethasone suppression test was completed, which resulted in persistently elevated Testosterone levels. As the lab work was not suggestive of an adrenal source of hyperandrogenism, she was subsequently referred for a bilateral salpingo-oophorectomy. Pathology confirmed a diagnosis of OSH and post-surgery lab work noted a normalization of her Testosterone levels. Clinical Lessons: Hyperandrogenism encompasses a variety of symptoms and is challenging to diagnose in patients with multiple underlying medical conditions or treatment history that can account for them. For instance, one of the hyperandrogenism symptoms our patient experienced was vertex hair loss, but this may have been attributed to her prior chemotherapy. Her history of chemotherapy was also interesting as we considered the possibility that her early menopause induced by chemotherapy could have contributed to her developing OSH. Lastly, OSH is rare (reported as 1:300 to 1:1000 cases) and may also present with normal imaging findings, which makes diagnosis even more challenging. Conclusion: We present a rare case of hyperandrogenism that was found to be secondary to OSH and resulted in biochemical resolution after surgical intervention. The diagnosis of OSH is difficult but important to consider when the clinical suspicion is high. Presentation: Sunday, July 13, 2025