Ovarian hyperthecosis: case report of an uncommon cause of hyperandrogenism

Hirsutism in postmenopausal women demands careful clinical evaluation; malignant causes are not infrequent and must be excluded, especially when virilization or a testosterone level of > 5nmol/L is present. Ovarian hyperthecosis (OH) is an uncommon, benign cause of marked hyperandrogenism. A 61-year-old post-menopausal woman presents with a year-long history of hirsutism, particularly on her face, chest, and abdomen. She had a BMI of 32kg/m2, an uncharacteristic phenotype, and slight clitoromegaly with no other virilization symptoms. Despite discrete symptoms, blood tests showed severe hyperandrogenism with total testosterone levels > 12nmol/L (~346 ng/dL). The abdominopelvic CT scan and transvaginal ultrasound were normal. A laparoscopic diagnostic salpingo-oophorectomy was performed, and histology revealed bilateral OH. Testosterone levels normalized one month after surgery. OH requires a high degree of suspicion and bilateral salpingo-oophorectomy is both diagnostic and therapeutic. Early diagnosis is crucial to optimize the treatment of comorbidities and prevent long-term complications.