SUN-108 Occult Bilateral Leydig Cell Tumors in a Postmenopausal Woman with Hyperandrogenism: A Rare Diagnostic Challenge

Abstract Disclosure: Y. Prystupa: None. U. Ahmad: None. IntroductionLeydig cell tumors (LCTs) are rare androgen-secreting ovarian neoplasms, accounting for only 0.5% of all ovarian tumors. These tumors are typically benign, unilateral, and often detectable on imaging. However, bilateral occult presentations are exceptionally rare and pose significant diagnostic challenges. This case highlights the importance of considering LCTs in postmenopausal women with unexplained hyperandrogenism, even when imaging studies are unremarkable. Early recognition and surgical intervention are crucial for effective management. Clinical case: A 72-year-old woman was referred to the endocrinology clinic for evaluation of elevated testosterone levels. Laboratory results revealed markedly elevated serum total testosterone (135 ng/dL; normal range: 2–45 ng/dL) and free testosterone (25.4 pg/mL; normal range: 0.2–5.0 pg/mL). To determine the source of androgen excess, imaging studies—including transvaginal ultrasonography, abdominal and pelvic CT, and adrenal/ovarian MRI—were performed, all of which were unremarkable. Despite the absence of detectable lesions, clinical suspicion for an androgen-secreting tumor remained high. The patient subsequently underwent a laparoscopic bilateral salpingo-oophorectomy. Histopathological examination confirmed the presence of bilateral LCTs. Postoperatively, serum testosterone levels returned to normal, confirming the tumors as the source of androgen excess.ConclusionThis case illustrates the diagnostic challenges of occult LCTs in postmenopausal women with hyperandrogenism and normal imaging findings. In cases of unexplained androgen excess, clinicians should maintain a high index of suspicion for occult ovarian tumors, even when imaging studies fail to identify a lesion. Definitive diagnosis often requires surgical exploration and histopathological evaluation, as small tumors may evade radiologic detection. In this case, bilateral LCTs were diagnosed solely through histopathology, highlighting the importance of thorough diagnostic approach and timely surgical intervention in similar presentations. Presentation: Sunday, July 13, 2025