SAT-162 - A Rare Case of Virilization Secondary to Dual Androgenic Tumors of the Adenal and Ovary

Background :
Hyperandrogenic tumors in women are extremely rare [ovarian (0.2–1%),adrenal
(<0.2%)]. More so, dual ovarian and adrenal androgenic tumors are still rarer with
only 2 cases reported in literature.

Case:
61 year old referred to endocrine clinic in 2010 by her surgeon brother age of 46
years for severe uncontrolled hypertension since 18 months with two
antihypertensive agents,masculine voice change with severe hirsutism and Irregular
menses O/E :frontal balding,hair thinning,male voice,severe hirsutism
over face ,upperlip,chin ,chest and back (F&G score 18 ). General
condition was good .BP was 150/94 mmHg
on amlodipine and telmisartan .Her S Testosterone (T): 399 ng/dl (2.9-45); S
DHEAS: 432 microgm /dl (45-345),Overnight dexamethasone suppression test :
ODS 8 am cortisol was 1.01 microgm /dl;PRA/aldosterone ratio and 24 hour urinary
metanephrines was normal. CT scan of abdomen and pelvis showed Left adrenal
tumor size 2X2 cm with L bulky ovary .Left adrenalectomy was done and reported as
benign Left adrenal adenoma.Post op T level 69 ng/dl and BP normalized in a month
off antihypertensives and laser therapy done for hirsutism
2 nd presentation 2014: was 2 years menopausal, new onset T2DM , F-156 mg/dl and
PPBG 245 mg/dl,HbA1c 7.8% with Multinodular goitre .TSH 3.2 IU/l.Total T :143.38
ng/dl (10.83-56.94) Was advised metformin and PET CT abdomen to see for
recurrence which showed MNG with hypodense nodules in both lobes largest 12x10
mm.FNAC thyroid: Benign (Category II) with no ovarian or adrenal abnormality
3 rd presentation 2023 :with high BP again, hair fall and balding and growth of facial
hair again.Total Tesosterone (ECLIA) :558ng/dl(2.9-40.8);S DHEAS :156 microgm
/dl (20-240);S.17-OHP: 1.2.PET CT: left adnexal hyperdense lesions in broad
ligament 3.5x4.1x5.0cm with increased vascularity. CT adrenals: 0.9x0.8x0.7 mm
right adrenal adenoma and absent left adrenal.Total laproscopic Hysterectomy with
excision of Left ovarian mass was done. Report: Sex cord stromal tumor possibility
of Sertoli Leydig cell tumour.Total Tesosterone :2.99ng/dl(2.9-40.8) after 1 month of
surgery and patient was asymptomatic
4 th presentation 2024 :With well controlled HT and T2DM with euthyroid MNG with
new onset polyarthritis of all joints.RA Factor :236 IU/ml ;ESR -31mm at end of 1 st
hour;CRP-14 mg/L; so treated by rheumatologist for Rheumatoid Arthritis

Currently her BP,RA and DM controlled ,Facial hair treated with laser, balding improved and is Planning a Euthyroid MNG
surgery as her largest nodule has increased to 3.2x 2.7x2.1 cm.R adrenal adenoma was non functional
Comprehensive genomic profiling to identify any
genetic link eventually.
Disscussion
Dual tumor presentations, particularly one ovarian and one adrenal
that too sequentially are extremely rare and should be considered when both T and
DHEAS are elevated, and imaging suggests multiple foci and need life long follow up.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*