Virilización y enfermedad metabólica en mujer postmenopáusica relacionado a hiperplasia e hipertecosis ovárica

Agustina Lucila Larrea; Vicente Ricardo González; Pablo Knoblovits; Santiago José Gil

doi:10.31053/1853.0605.v78.n2.32136

Authors

Agustina Lucila Larrea
Vicente Ricardo González
Pablo Knoblovits
Santiago José Gil

DOI:

https://doi.org/10.31053/1853.0605.v78.n2.32136

Keywords:

virilism, diabetes insipidus, thecoma

Abstract

During menopausal transition, mild clinical signs of hyperandrogenism may appear as part of the normal aging process, but the development of frank virilization suggests a specific source of androgen excess. In this context, androgen-secreting tumors at both adrenal and ovarian levels should be ruled out.

We present the case of a 51-year-old postmenopausal woman with signs of 12 month period virilization, associated with personal history of type 2 diabetes and arterial hypertension, poorly managed in the past year. Laboratory tests showed elevation of serum androgen levels and hyperinsulinemia. Images were requested, revealing both enlarged homogeneous and solid ovaries, with preserved adrenal glands, which led to suspicion of a possible thecal hyperplasia of the ovarian stroma. Laparoscopic bilateral adnexectomy was performed and the pathological report confirmed the presumptive diagnosis. One month later after surgery, serum testosterone levels returned to values close to spected for a postmenopausal woman.

Finding the source of virilization in postmenopausal women is challenging, and they are usually associated with rare pathologies. A detailed medical history is essential to differentiate the progressive development of virilization that characterizes benign causes from the rapid progression that characterizes malignant tumors. The adequate interpretation of laboratory tests with complementary images, as well as looking for the association of pathologies causing elevated cardiovascular risk such as diabetes and hypertension are essential to establish a right diagnosis and treatment.

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Author Biographies

Agustina Lucila Larrea

Specialist in Gynecology and Obstetrics. Current Fellow of Benign Pelvic Pathology and Mini Invasive Surgery at the Hospital Italiano de Buenos Aires.
Vicente Ricardo González

Specialist in Internal Medicine and Emergentology. Current Resident of the Endocrinology, Metabolism and Nuclear Medicine Service of the Hospital Italiano de Buenos Aires.
Pablo Knoblovits

Specialist in Endocrinology, Metabolism and Nuclear Medicine. Current staff physician of the Endocrinology, Metabolism and Nuclear Medicine service of the Hospital Italiano de Buenos Aires. Associate Professor of the Department of Medicine of the Italian Hospital of Buenos Aires. Member of the Committee of the Journal of the Italian Hospital of Buenos Aires.
Santiago José Gil

Gynecologist Specialist in Reproduction. Current staff physician of the Gynecology service, Head of the Benign Pelvic Pathology Section of the Italian Hospital of Buenos Aires.

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