Postmenopausal Hyperandrogenism in a Patient With an Adrenal Adenoma: How Should We Approach It?

ABSTRACT Objective: To report the case of a postmenopausal woman with adrenal adenoma and severe hyperandrogenism due to bilateral ovarian hyperthecosis. Methods: We describe the clinical findings and diagnostic tests used to determine the source of excess androgen. Results: A 57-year-old postmenopausal woman with a 3-year history of alopecia and hirsutism was referred for evaluation. Laboratory evaluations revealed an elevated testosterone concentration. Transvaginal ultrasonography was normal but computed tomography showed a left adrenal nodule. Ovarian and adrenal vein sampling showed a gradient of testosterone between peripheral and right ovarian veins. Her testosterone concentration normalized following treatment with a gonadotropin-releasing hormone agonist. Following bilateral oophorectomy, her elevated testosterone concentration returned to normal and signs of hyperandrogenism gradually receded. Conclusion: Suppression of gonadotropin-releasing hormone and both adrenal and ovarian venous sampling are useful methods for determining the source of excess androgen, particularly if diagnostic imaging results are negative or are inconsistent with androgen determinations. Abbreviations: CT = computed tomography GnRH = gonadotropin releasing hormone DHEAS = dehydroepiandrosterone sulfate