Hyperandrogenism of ovarian etiology: utilizing differential venous sampling for diagnosis.

Background: We report the diagnosis and management of testosterone hypersecretion in the presence of an adrenal mass and no initially discernible ovarian mass.

Case: A 64-year-old woman with severe hyperandrogenism, including serum testosterone 392 ng/dL, male-pattern baldness, and hirsutism, required bilateral ovarian and adrenal venous sampling to determine the source of the testosterone. Once an ovarian origin was confirmed, total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed for definitive treatment. The adrenal adenoma was left in situ. There was a dramatic decrease in subjective symptomatology and normalization of testosterone postoperatively.

Conclusion: Preoperative differential venous sampling determined the correct source of testosterone. Subsequent removal of the ovary and steroid cell tumor correctly treated the hyperandrogenism and avoided an unnecessary surgical procedure for the adrenal adenoma.