A Young Female with Secondary Amenorrhea and Hirsutism: A Rare Case Report of Steroid Cell Tumor of the Ovary

Abstract

Objective: To report a case of a young female with longstanding secondary amenorrhea and hirsutism, ultimately diagnosed with an ovarian steroid cell tumor.

Methodology: A comprehensive review of the patient’s clinical presentation, biochemical profile, radiological findings, surgical intervention, and histopathology was undertaken.

Results: A 25-year-old female presented with secondary amenorrhea and progressive hirsutism for five years, accompanied by weight gain and elevated blood pressure for two years. She reported regular menstrual cycles until 2015. Clinical examination revealed a Ferriman-Gallwey score of 25, without signs of proximal myopathy or striae. Laboratory investigations showed markedly elevated serum testosterone (527 ng/dL), low luteinizing hormone (LH 0.14 mIU/mL), and low follicle-stimulating hormone (FSH 0.76 mIU/mL). Thyroid function tests and DHEA-S levels were within normal limits. Serum 17-hydroxyprogesterone (17-OHP) was elevated (10.9 ng/mL), and the overnight dexamethasone suppression test (ODST) was normal (0.70 µg/dL). Pelvic CT imaging revealed a left ovarian mass adherent to the sigmoid colon and in close proximity to the uterus and contralateral ovary. She underwent exploratory laparotomy, left salpingo-oophorectomy, and total omentectomy for tumor removal. Postoperatively, serum testosterone and 17-OHP levels normalized, and the patient resumed menstruation.

Conclusion: In women presenting with signs of virilization, a thorough evaluation is essential to differentiate between adrenal and ovarian sources of androgen excess. Although rare, ovarian steroid cell tumors should be considered in the differential diagnosis of hyperandrogenism in adult females.