We report a case of a 66-yr-old woman with progressive hair balding,
hirsutism and
virilization.
Gonadotropins and
estradiol levels were in the postmenopausal range; total
testosterone (TT), free
testosterone (FT) and
17-hydroxyprogesterone (17-OHP) were elevated with
dehydroepiandrosterone sulphate, androstendione and
cortisol serum levels in the normal range, as 24-hr free urinary
cortisol. TT, FT and 17-OHP were normalized, and FSH and LH fell to premenopausal levels on 18th day after a single i.m. injection of the
GnRH analogue (GnRHa),
triptorelin. Then, a diagnosis of
hyperandrogenism of ovarian origin was made and
bilateral ovariectomy was performed. Histological study of gonadal tissue revealed diffuse stromal
hyperplasia of both ovaries with occasional nests of luteinized cells. With immunoperoxidase techniques these cells stained positively for
testosterone and
progesterone. One month after surgery,
androgen levels were normalized together with regression of most of the clinical signs of
virilization. In conclusion, our patient showed a severe
virilization developed after menopause; hormonal investigations suggested a
gonadotropin dependent ovarian
hyperandrogenism, confirmed by histological examination; the presence of luteinized cells in the ovarian stroma was responsible for
hyperandrogenism, as confirmed by the immunoperoxidase technique.