A Case of Idiopathic Post-Menopausal Hirsutism Mimicking an Androgen-Producing Right Ovarian Mass

Ambekar AN, Sanjeev NK, Sonwane AC, Vikrant M, Kondapalli R, Sethi BK, Srinivas K and Modi KD

Published on: 2025-07-11

Abstract

A 62-year-old female presented to the endocrinology outpatient department for facial hirsutism (Ferriman-Gallwey score 5/36) of 5 years duration. She had no other virilizing features. In the background, she had Type 2 diabetes of 8 years duration, reasonably controlled (HbA1C 7.4%) on twice daily premixed insulin with Metformin 1000 mg/day. Her workup revealed elevated serum testosterone (0.80 ng/mL) with normal levels of other hormones. USG pelvis showed a large (16x12 cm) mixed echogenic right ovarian cyst with a solid component. With suspicion of an androgen-producing right ovarian mass, she underwent surgery for removal of the mass. Postoperative histopathology showed nests of transitional epithelium with squamous metaplasia, consistent with a Brenner tumour. In subsequent follow-up, 3 months after surgery, her hirsutism was the same, with serum testosterone in a similar elevated range. Even though Brenner tumour is rarely reported to produce increased androgen, in this case, it appears coincidental. Mild hirsutism, absence of virilizing features, mildly elevated serum testosterone, and absence of improvement after surgery indicate this case as idiopathic post-menopausal hirsutism rather than an androgen-producing ovarian tumour.