A case report of a patient with a Leydig cell tumor, poor blood pressure control, and ventricular septal hypertrophy

Purpose

We report the first case of a testosterone-secreting Leydig cell tumor of the ovary in an elderly female patient with hyperandrogenism, who had poor blood pressure control and a thickened ventricular septum. After surgical removal of an ovarian Leydig cell tumor, the patient’s blood pressure improved, as well as her ventricular septal hypertrophy significantly at the 2-year follow-up.

Case summary

After menopause, a 76-year-old woman began presenting with increasing facial and body hair, masculine appearance, and deepening voice. The patient had a history of hypertension for more than 10 years, coronary atherosclerosis, and an old cerebral infarction. She reported the long-term use of nifedipine 30 mg + perindopril 4 mg + metoprolol 47.5 mg for antihypertensive treatment, yet her blood pressure was still poorly controlled. The results of the laboratory, radiological, and pathological examinations for this case are described, and the patient was followed up for 2 years. In addition, the relevant literature was reviewed. Blood test results revealed elevated levels of estradiol (332.95 Pmol/L [nl range: 73.4–172.49 Pmol/L]), testosterone 25.27 nmol/L [nl range: 0.52–2.43 nmol/L]) and 17α-OHP (3.0 ng/mL [nl range: <0.93 ng/mL]). After excluding adrenal gland dysfunction as a potential cause, the patient underwent laparoscopic total hysterectomy + bilateral salpingo-oophorectomy under general anesthesia and was diagnosed with an ovarian Leydig cell tumor. Postoperative re-examination indicated a decrease in her estradiol (158.3 Pmol/L), and testosterone levels (1.45 nmol/L). Her blood pressure and other clinical symptoms had improved significantly. The patient's ventricular septal hypertrophy had improved significantly by the 2-year follow-up.

Conclusion

A testosterone-secreting Leydig cell tumor of the ovary can be the primary cause of poorly controlled hypertension and aggravated ventricular septal hypertrophy.