231 KB40 KB199420252023Dolenšek, ŽivaKocjan, Tomažštevilka:1letnik:62str. 43-54ISSN:0025-8121COBISSID_HOST:149423107URN:URN:NBN:SI:doc-JT4J4D1SslMedicinski razglediMedicinski razgledihiperandrogenizemhyperandrogenismmenopausemenopavzaprolactinomaprolaktinomHiperandrogenizem po menopavzi| Hyperandrogenism after menopause|Postmenopausal hyperandrogenism results from absolute or relative androgen excess. It presents with hirsutism, acne, and androgenetic alopecia, in most severe cases with virilisation. We must differentiate between rare tumorous, and common, nontumorous (functional) causes. Diagnosis is based on a detailed history and clinical examination, followed by the measurement of dehydroepiandrosterone-sulphate and testosterone with additional hormone testing and imaging when necessary. We present a 51-year-old post- menopausal patient with severe, rapidly progressing hyperandrogenism and substantially elevated total testosterone. She was diagnosed with acromegaly due to an elevated insu- lin growth factor-1 and pituitary tumor on MRI, despite lacking acromegalic features and appropriate growth hormone suppression after glucose load. A second opinion was reque- sted by the neurosurgeon. We found a Leydig tumor of the right ovary. After a bilateral salpingo-oophorectomy, testosterone levels normalized and hyperandrogenism subsided. Since the insulin growth factor-1 also normalized, we concluded that its high levels were caused by the stimulatory effect of testosterone on the somatotropic axis. The pituitary tumor was recognized as macroprolactinoma. Prolactin normalized with a dopaminergic agonist. A follow-up MRI is scheduled to confirm the tumor shrinkage. If hyperandroge- nism is clinically suspected in a postmenopausal female, we need to determine the seve- rity, timing of the onset, and progression of hyperandrogenism as well as measure the serum androgen values. When there is a combination of etiologies for hyperandrogenism, the diagnosis can be challenging – as it was in the presented case. Optimal management of patients with a pituitary tumor always includes the determination of the functional reserve of the gland, and further testing in case of clinical suspicion of pituitary hormone hypersecretionTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaDruštvo Medicinski razgledi