Postmenopausal Hyperandrogenism.

Abstract

Hirsutism is a fairly common diagnosis affecting 10% of women [1]. Mild symptoms are not always brought to medical attention, but severe cases, especially in menopause that are associated with hyperandrogenism, require evaluation and treatment. We present a case of postmenopausal hirsutism to demonstrate the diagnostic and therapeutic challenges seen in practice. A 55 year-old postmenopausal woman with history of multi nodular goiter, autoimmune hepatitis, lupus erythematosus panniculitis, diabetes and acid reflux presents with restlessness, increased libido, hair loss, worsening hirsutism, and 25-pound weight loss over 2 months. Medications include azathioprine, metformin, lisinopril, and omeprazole. Physical examination revealed BMI of 34 kg/m2, severe hirsutism (FerrimanGallwey score of 18), receding hairline, goiter, prior scarring from abdominal procedures and normal external genitalia without clitoromegaly. Labs included TSH 1.05 (normal 0.5-4.5), hemoglobin A1c of 6.1% (normal <5.7), LH 29.8 mIU/mL (normal 20-70), FSH 38.5 mIU/mL (normal 30-120), total testosterone 94.7 ng/dL (normal 7-40), free testosterone 2.2 ng/dL (normal <1), estradiol 28.5 pg/mL (normal <20), DHEA-S 25.2 μg/dL (normal 15-200), cortisol 7.1 μg/dL (normal 7-20) and ACTH 15 pg/mL (10-60 pg/mL). Screening tests for occult Cushing’s syndrome and pheochromoctyoma were negative.