Leydig cell ovarian tumour: a rare cause of hyperandrogenism

We present a case of a postmenopausal woman with androgenic alopecia and very high testosterone levels of 16 nmol/L (normal range 0.4–1.2). CT showed an enlarged right ovary with a high-density nodule and an incidental adrenal nodule. She underwent bilateral salpingo-oophorectomy and pathology confirmed a benign Leydig cell tumour of the right ovary and Leydig cell hyperplasia of the left. Testosterone levels improved to near normal postoperatively. Adrenal investigations favoured a benign adenoma, although adrenal androgen production could not be ruled out.

This case highlights the challenges in investigating hyperandrogenism in postmenopausal women; the most common causes are ovarian and adrenal in origin. Leydig cell tumours are rare androgen-secreting benign ovarian tumours. The treatment of choice is bilateral salpingo-oophorectomy and provides cure in most cases.