Progressive
hirsutism can be a symptom of an
androgen-producing
tumor, especially in postmenopausal women. We report a case of a 58-year-old woman who complained of progressive
hirsutism, nervousness, irritability, anxiousness and an increased libido. Examination showed an unusual redness of her head, décolleté, palms and soles of her feet. Basal laboratory tests revealed a profound elevation of
testosterone levels (7.5 microg/l) and normal levels of androstendione,
dehydroepiandrosterone-sulfate, 17alpha-hydroxy-progesterone and
thyroid-stimulating hormone. Also remarkable was that her red blood count,
hemoglobin and hematocrit values were elevated while
erythropoietin was within normal limits. Functional laboratory tests ruled out heterozygous C21-hydroxylase deficiency and showed a moderate
insulin resistance on the oral
glucose tolerance test. Transvaginal ultrasound revealed a slightly hyperdensic area of 6 mm in the left ovary. Magnetic resonance imaging showed a contrast medium-accumulating area of 2 cm in the left ovary. Since the patient was initially reluctant to undergo surgery, a
GnRH-analogue (triptoreline) was administered VIA
intramuscular injection once per month for two months and
testosterone levels were lowered to less than one third of the initial level (2 microg/l). Surgery was eventually performed with laparoscopic bilateral salpingoophorectomy, hysteroscopy and uterine
curettage. The histologic examination revealed a
Leydig cell tumor in the hilus and stroma of the left ovary. Postoperatively
testosterone levels dropped dramatically and instantly into the normal range. Within months, the red blood count and hematocrit levels were within normal limits. The patient's face became more feminine, the redness of her face and
hirsutism regressed. Her anxiousness and nervosity resolved and the
insulin sensitivity improved. In this paper, polyglobulia, the metabolic and psychological changes due to
hyperandrogenism are discussed, as well as the phenomenon that the
tumor responded to a
GnRH-analogue. Such a response implies that the
tumor is either under
gonadotropin control or that
GnRH analogues have direct effects via receptors on tumorous Leydig cells.