SUN-115 Leydig Cell Tumor: A Rare Cause of Hyperandrogenism

Abstract Disclosure: O. Onwudiwe: None. A.M. Aviles Melendez: None. K. Rajamani: None. Background: Leydig cell tumors of the ovary are rare benign tumors originating from the gonadal stroma, accounting for 0.5% of all ovarian tumors. These tumors can occur at any age but are most common in postmenopausal women. They are associated with hyperandrogenism, often leading to rapid medical attention due to social and physical implications, such as elevated testosterone levels. This case describes a soprano singer who experienced voice deepening and was found to have a Leydig cell tumor of the ovary. Case: A 72-year-old woman with a history of invasive ductal breast carcinoma presented with clitoromegaly, hirsutism, deepening voice, and male pattern hair loss. Her breast cancer, diagnosed two years prior, had been treated with chemotherapy, mastectomy, radiation, and Anastrozole, leaving her in remission. Elevated testosterone levels were detected during evaluation. An abdominal CT and pelvic ultrasound showed no adrenal or ovarian masses. Anastrozole was suspected to be the cause of her hyperandrogenism, so it was replaced with Tamoxifen. However, repeat bloodwork after three months still showed elevated testosterone, and her symptoms persisted. An MRI identified a 2 cm mass on the left ovary, leading to a diagnosis of a hormonally active Leydig cell tumor. She underwent bilateral salpingo-oophorectomy, and pathology confirmed the diagnosis. Post-surgery, her testosterone normalized, clitoromegaly resolved, her voice returned to normal, and she regained her ability to sing. At follow-up, her hair was re-growing, and she resumed Anastrozole therapy. Discussion: Hyperandrogenism in women, as seen in this case, can be distressing. In reproductive-age women, it is often caused by polycystic ovarian syndrome (PCOS), but in postmenopausal women, adrenal or ovarian tumors must be considered. Other causes, such as hypothyroidism or acromegaly, should also be excluded. Anastrozole, an aromatase inhibitor, can complicate diagnosis by increasing androgen levels, as it blocks the conversion of testosterone to estrogen. In this case, imaging eventually identified a Leydig cell tumor, a rare benign cause of virilization. Most postmenopausal virilizing ovarian tumors are benign, and bilateral salpingo-oophorectomy is curative. Conclusion: Sudden hyperandrogenism in postmenopausal women warrants investigation for hormonally active ovarian tumors. These tumors, though distressing, are curable with surgery. Long-term follow-up is essential to monitor for recurrence or metastasis, even in benign cases. Presentation: Sunday, July 13, 2025