Bilateral ovarian steroid cell tumor in a postmenopausal woman with progressive hyperandrogenism

Severe hyperandrogenism with new-onset virilization in postmenopausal women is rare and often associated with androgen-secreting tumors. Nevertheless, a comprehensive differential diagnosis must be considered, including ovarian hyperthecosis and Cushing syndrome. We report a 71-year-old woman with progressive hirsutism over 1-2 years, presenting with severe hyperandrogenism and insulin resistance. Physical examination revealed moderate hirsutism with a score of 15 according to the modified Ferriman-Gallwey scale, androgenic alopecia, dental diastema, macroglossia, and acanthosis. Hormonal analysis demonstrated elevated free testosterone levels on two separate occasions: 8.1 ng/mL (SI: 28 nmol/L) and 6.7 ng/mL (SI: 23.2 nmol/L) (reference range 0.12-0.35 ng/mL [SI 0.42-1.22 nmol/L]); with all other androgenic parameters within the normal range. Imaging studies, including abdominal computed tomography (CT) and transvaginal ultrasound, showed normal adrenal glands and adnexa. Based on clinical suspicion, the patient underwent bilateral adnexectomy. Histopathology confirmed a bilateral ovarian steroid cell tumor, not otherwise specified. Postoperatively, serum testosterone normalized (0.16 ng/mL [SI: 0.55 nmol/L]) within one month with progressive improvement in hirsutism.