SUN-105 A Classic Case of Ovarian Hyperthecosis

Abstract Disclosure: E. Krishnaraju: None. S. Samarasinghe: None. Introduction: Ovarian hyperthecosis (OH) is a rare cause of hyperandrogenism typically seen in postmenopausal women. Severe hyperandrogenism with testosterone levels over 150 ng/dL but slowly progressive clinical signs of virtualization and metabolic complications characterize this disease. Clinical Case: A 62-year-old woman was being followed in the clinic for diabetes mellitus, atrial flutter, obstructive sleep apnea, hypertriglyceridemia, kidney stones, proteinuria, obesity, coronary artery disease, and a partial hysterectomy for uterine fibroids. She presented with symptoms of gradual but worsening hair loss in an androgenic pattern and hirsutism for 1-2 years. On exam, she had facial plethora, a dorsal hump, central obesity, thin yet muscled extremities, and male-pattern balding. She was also noted to have coarse facial hair and normal external genitalia. Lab work was remarkable for a high serum testosterone of 238 ng/dl, free testosterone of 24.2 pg/ml, FSH of 57.6 miu/ml, and LH of 51.6 miu/ml. She had a normal TSH, prolactin, estradiol DHEA-S, and SHBG level. Several late-night salivary cortisol levels were normal and a 1 mg DST showed a suppressed cortisol of 1.6 ug/dl. A CT adrenal demonstrated normal appearing adrenal glands while an MRI pelvis showed an absent uterus but noted an enlarged 2.7 cm right ovarian cyst. The right ovary measured 3.0 x 2.6 x 3.6 cm and the left ovary measured 2.4 x 1.7 x 1.9 cm with both glands exhibiting homogeneous enhancement and a normal T2 signal without solid lesions. Given the markedly elevated testosterone levels and the findings of an ovarian cyst, the patient underwent an exploratory laparotomy with bilateral salpingo-oophorectomy. The final histopathology revealed ovarian stromal hyperthecosis of both ovaries with positive immunohistochemical stains for inhibin and calretinin. Her postoperative testing confirmed normalization of testosterone at 21 ng/dl at four weeks and 29 ng/dl at one year after surgery. Her symptoms of hirsutism and hair loss gradually improved after surgery but her body weight and overall appearance remain unchanged. Conclusion: OH must be considered in the differential of severe hyperandrogenism. Other etiologies include hormonally active ovarian and adrenal tumors. OH classically causes ovarian enlargement, but should be suspected even with normal-sized ovaries on imaging. Prompt referral for oophorectomy and histopathologic diagnosis is the gold standard for management. Presentation: Sunday, July 13, 2025