A Rare Case of Ovarian Hilar Leydig Cell Tumor in A Postmenopausal Woman Presenting with Clitoromegaly

ABSTRACT Objective: Acquired clitoromegaly is a relatively rare condition, with hyperandrogenism among the possible etiologies. We report the case of a postmenopausal woman who presented with acquired clitoromegaly that was caused by a Leydig cell tumor, a rare type of ovarian tumor. Method: Clinical, laboratory, imaging, and pathology data are presented. Results: A 66-year-old postmenopausal female was referred to the endocrine office for evaluation of hyperandrogenism after she was found to have an enlarged clitoris on her annual gynecologic exam. Laboratory work-up was remarkable for elevated levels of total and free testosterone, 17-hydroxyprogesterone, and androstenedione concurrent with normal levels of dehydroepiandrosterone sulfate, sex hormone–binding globulin, follicle-stimulating hormone, luteinizing hormone, estradiol, prolactin, random cortisol, and thyroid-stimulating hormone. Pelvic ultrasound and abdominal/pelvic computed tomography were unrevealing. Given the concern for an ovarian malignancy, the patient underwent a laparoscopic bilateral salpingo-oophorectomy. Pathology showed a left ovarian hilar Leydig cell tumor with a benign mucinous cyst. Postoperatively, her total and free testosterone normalized. Conclusion: Acquired clitoromegaly and ovarian Leydig cell tumors are both rare entities. New clitoromegaly in postmenopausal women necessitates careful evaluation for biochemical evidence of hyperandrogenism. Abbreviations: DHEA-S dehydroepiandrosterone sulfate PCOS polycystic ovary syndrome SLCT Sertoli-Leydig cell tumor