Case and Research Letters
Alopecia and Hirsutism in a Postmenopausal Woman as the Presenting Complaint of Ovarian Hilus (Leydig) Cell Tumor
Alopecia e hirsutismo en una mujer posmenopáusica como forma de presentación de un tumor de células de Leydig hiliar del ovario
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Berbegal, M.P. Albares, F.J. De-Leon, G. Negueruela" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Berbegal" "email" => array:1 [ 0 => "lauraberbegal@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.P." "apellidos" => "Albares" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "F.J." "apellidos" => "De-Leon" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "G." "apellidos" => "Negueruela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Endocrinología, Hospital General Universitario de Alicante, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alopecia e hirsutismo en una mujer posmenopáusica como forma de presentación de un tumor de células de Leydig hiliar del ovario" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 812 "Ancho" => 2168 "Tamanyo" => 330204 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Triangular-shaped frontoparietal hairline recession. B, Hair thinning on the crown.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Female androgenetic alopecia is one of the main causes of hair loss, and affects 50% of women in their lifetime.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Alopecia and hirsutism as a manifestation of hyperandrogenism in postmenopausal women can have various causes, ranging from normal physiological changes to an ovarian or adrenal tumor. Recommended tests in any woman presenting with alopecia are a detailed clinical history, physical examination, general blood tests (including complete blood count and thyroid stimulating hormone and ferritin levels) and a hormone study with measurement of dehydroepiandrosterone sulfate and total and free testosterone levels.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 65-year-old woman who presented with a 1-year history of hair loss and black facial hair. There was no past history of alopecia, hirsutism, or hyperandrogenism. Her history was remarkable for cardiovascular risk factors (hypertension, dyslipidemia, and diabetes mellitus), and she was also being monitored by the endocrinology department for euthyroid goiter. The physical examination showed frontoparietal hair loss in a triangular-shaped pattern (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> A) and diffuse thinning on the crown (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> B). These findings were consistent with male-pattern female hair loss grade II in the Ebling classification system. The patient also had hirsutism (Ferriman-Gallwey score 9), located predominantly on the face and sides of the neck but also in the chin area (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Examination of the external genitalia revealed an enlarged clitoris. There were no other signs of virilization, such as voice deepening or increased muscle bulk.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Considering the physical findings, we requested blood tests with complete blood count, biochemistry, erythrocyte sedimentation rate, thyroid hormones, and iron profile. The results were all within normal ranges. A hormone study showed hyperandrogenism, with elevated testosterone levels (4.06<span class="elsevierStyleHsp" style=""></span>ng/mL; normal range, 0.20-0.80<span class="elsevierStyleHsp" style=""></span>ng/mL). The tests also showed a level of 28<span class="elsevierStyleHsp" style=""></span>nmol/L for sex hormone binding globulin (normal range, 11-124<span class="elsevierStyleHsp" style=""></span>nmol/L) and a free testosterone index of 45 (normal range, 1.6-6). Free testosterone is the biologically active fraction of testosterone. Androstenedione, dehydroepiandrosterone sulfate, and 17-hydroxyprogesterone levels were all within normal limits. Estradiol levels were high due to peripheral aromatization of testosterone.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The results suggested an ovarian tumor and we ordered a vaginal ultrasound, which revealed no alterations. The patient was referred to the endocrinology department for further testing, including tumor marker and imaging tests. Prolactin and cortisol tests were normal, as were the results for all tumor markers analyzed except carcinoembryonic antigen, with a level of 14.5<span class="elsevierStyleHsp" style=""></span>ng/mL (normal range, 0-5<span class="elsevierStyleHsp" style=""></span>ng/mL). An abdominal computed tomography scan showed images consistent with a left adrenal tumor (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Magnetic resonance imaging of the pelvis showed no signs of an ovarian tumor. With these findings, it was decided to perform a left adrenalectomy, but the patient continued to show high testosterone levels (4.06<span class="elsevierStyleHsp" style=""></span>ng/mL; normal range, 0.20-0.80) and a high free testosterone index (42.6; normal range, 1.6-6) after the operation. Finally, given the strong suspicion of hyperandrogenism of ovarian origin, we performed a bilateral adnexectomy.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The histologic study confirmed a diagnosis of Leydig cell tumor, hilar type, in the right ovary. At the time of writing, 2 months after the adnexectomy, the patient's testosterone levels have returned to normal and there are evident improvements in her hirsutism and alopecia.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Alopecia and hirsutism can be the presenting manifestation of a tumor,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> as shown by the case reported herein. Hilar Leydig cell tumors of the ovary are very rare and account for just 0.5% of all ovarian tumors. Accordingly, very few cases have been described in the literature. Although benign, these tumors frequently cause virilization, with increased androgen production,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3–5</span></a> and they are also associated with an increased risk of thromboembolism.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Leydig tumor cells in the ovary can be very small and may go undetected in imaging studies. This is why adnexectomy is frequently performed as part of a diagnosis of exclusion.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Adnexectomy of just the affected ovary is an option in premenopausal women. The ovary to be removed is identified during surgery by measuring testosterone levels in the ovarian veins.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Hyperandrogenism, particularly with signs of virilization, is very uncommon in postmenopausal women and tends to be due to tumors (mainly of ovarian or adrenal origin).<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Other causes that should be ruled out, however, are drugs, pituitary disorders, and the ectopic production of hormones by tumors. The severity of the hyperandrogenism, the patient's age, and the speed with which signs and symptoms appear are all important diagnostic clues.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Berbegal L, Albares MP, De-Leon FJ, Negueruela G. Alopecia e hirsutismo en una mujer posmenopáusica como forma de presentación de un tumor de células de Leydig hiliar del ovario. Actas Dermosifiliogr. 2015;106:676–678.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 812 "Ancho" => 2168 "Tamanyo" => 330204 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Triangular-shaped frontoparietal hairline recession. B, Hair thinning on the crown.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1171 "Ancho" => 1660 "Tamanyo" => 375421 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hirsutism affecting the chin and sides of the face and neck.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1868 "Ancho" => 1626 "Tamanyo" => 296322 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Left adrenal nodule measuring 2.6<span class="elsevierStyleHsp" style=""></span>cm.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manejo de las mujeres posmenopáusicas en la alopecia androgenética" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 9 | 20 |
| 2024 Octubre | 122 | 59 | 181 |
| 2024 Septiembre | 126 | 49 | 175 |
| 2024 Agosto | 152 | 64 | 216 |
| 2024 Julio | 129 | 57 | 186 |
| 2024 Junio | 152 | 32 | 184 |
| 2024 Mayo | 144 | 53 | 197 |
| 2024 Abril | 109 | 34 | 143 |
| 2024 Marzo | 110 | 36 | 146 |
| 2024 Febrero | 87 | 37 | 124 |
| 2024 Enero | 67 | 35 | 102 |
| 2023 Diciembre | 106 | 20 | 126 |
| 2023 Noviembre | 82 | 35 | 117 |
| 2023 Octubre | 59 | 15 | 74 |
| 2023 Septiembre | 88 | 30 | 118 |
| 2023 Agosto | 67 | 22 | 89 |
| 2023 Julio | 83 | 30 | 113 |
| 2023 Junio | 79 | 25 | 104 |
| 2023 Mayo | 100 | 23 | 123 |
| 2023 Abril | 69 | 18 | 87 |
| 2023 Marzo | 80 | 20 | 100 |
| 2023 Febrero | 84 | 22 | 106 |
| 2023 Enero | 62 | 21 | 83 |
| 2022 Diciembre | 76 | 46 | 122 |
| 2022 Noviembre | 41 | 26 | 67 |
| 2022 Octubre | 42 | 26 | 68 |
| 2022 Septiembre | 40 | 33 | 73 |
| 2022 Agosto | 30 | 33 | 63 |
| 2022 Julio | 28 | 43 | 71 |
| 2022 Junio | 34 | 25 | 59 |
| 2022 Mayo | 37 | 29 | 66 |
| 2022 Abril | 298 | 39 | 337 |
| 2022 Marzo | 328 | 53 | 381 |
| 2022 Febrero | 63 | 30 | 93 |
| 2022 Enero | 65 | 48 | 113 |
| 2021 Diciembre | 52 | 36 | 88 |
| 2021 Noviembre | 55 | 60 | 115 |
| 2021 Octubre | 59 | 59 | 118 |
| 2021 Septiembre | 65 | 40 | 105 |
| 2021 Agosto | 52 | 29 | 81 |
| 2021 Julio | 34 | 34 | 68 |
| 2021 Junio | 24 | 24 | 48 |
| 2021 Mayo | 37 | 28 | 65 |
| 2021 Abril | 46 | 41 | 87 |
| 2021 Marzo | 65 | 25 | 90 |
| 2021 Febrero | 53 | 23 | 76 |
| 2021 Enero | 30 | 19 | 49 |
| 2020 Diciembre | 31 | 19 | 50 |
| 2020 Noviembre | 20 | 14 | 34 |
| 2020 Octubre | 31 | 8 | 39 |
| 2020 Septiembre | 44 | 13 | 57 |
| 2020 Agosto | 20 | 24 | 44 |
| 2020 Julio | 17 | 18 | 35 |
| 2020 Junio | 36 | 44 | 80 |
| 2020 Mayo | 27 | 19 | 46 |
| 2020 Abril | 34 | 21 | 55 |
| 2020 Marzo | 37 | 21 | 58 |
| 2020 Febrero | 4 | 1 | 5 |
| 2020 Enero | 6 | 2 | 8 |
| 2019 Diciembre | 8 | 0 | 8 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 5 | 5 |
| 2019 Septiembre | 6 | 4 | 10 |
| 2019 Agosto | 4 | 2 | 6 |
| 2019 Julio | 4 | 9 | 13 |
| 2019 Junio | 4 | 20 | 24 |
| 2019 Mayo | 6 | 32 | 38 |
| 2019 Abril | 5 | 22 | 27 |
| 2019 Marzo | 4 | 26 | 30 |
| 2019 Febrero | 3 | 29 | 32 |
| 2019 Enero | 13 | 11 | 24 |
| 2018 Diciembre | 8 | 7 | 15 |
| 2018 Noviembre | 11 | 0 | 11 |
| 2018 Octubre | 13 | 0 | 13 |
| 2018 Septiembre | 4 | 1 | 5 |
| 2018 Agosto | 0 | 5 | 5 |
| 2018 Julio | 0 | 8 | 8 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 10 | 10 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Marzo | 0 | 2 | 2 |
| 2018 Febrero | 26 | 4 | 30 |
| 2018 Enero | 27 | 7 | 34 |
| 2017 Diciembre | 33 | 9 | 42 |
| 2017 Noviembre | 20 | 3 | 23 |
| 2017 Octubre | 28 | 7 | 35 |
| 2017 Septiembre | 23 | 9 | 32 |
| 2017 Agosto | 23 | 5 | 28 |
| 2017 Julio | 15 | 8 | 23 |
| 2017 Junio | 25 | 15 | 40 |
| 2017 Mayo | 22 | 9 | 31 |
| 2017 Abril | 16 | 8 | 24 |
| 2017 Marzo | 5 | 26 | 31 |
| 2017 Febrero | 19 | 7 | 26 |
| 2017 Enero | 8 | 4 | 12 |
| 2016 Diciembre | 22 | 14 | 36 |
| 2016 Noviembre | 30 | 23 | 53 |
| 2016 Octubre | 27 | 21 | 48 |
| 2016 Septiembre | 0 | 1 | 1 |
| 2016 Julio | 2 | 1 | 3 |
| 2016 Junio | 3 | 0 | 3 |
| 2016 Enero | 0 | 1 | 1 |
| 2015 Noviembre | 0 | 1 | 1 |
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