Dual case insights shaping a new protocol for post-menopausal hirsutism
File(s)
Published version
Author(s)
Meeran, Karim
Einas, Mohamed
Type
Journal Article
Abstract
Hyperandrogenism in women typically presents with hirsutism and other virilizing features. When it presents with accelerated clinical features and/or very high androgen levels (total testosterone > 5 nmol/L) (>145 ng/dL) (reference range, <2.4 nmol/l [SI: <70 ng/dL]), particularly in the post-menopausal state, an underlying ovarian or adrenal neoplasm should be considered. With ovarian pathology, androgen-secreting ovarian tumors and ovarian hyperthecosis are the key differential diagnoses. The recommended treatment for an androgen-secreting ovarian tumor is surgical removal. In contrast, ovarian hyperthecosis may be managed conservatively, provided an androgen-secreting malignant tumor has been excluded. Clarifying this diagnostic uncertainty is a challenge, and imaging and biochemical tests are not always diagnostic. There is additionally a need for better medical treatment in patients with benign androgen-secreting ovarian tumors. We report two cases of female hyperandrogenism with a radiologically identified ovarian lesion, managed with a gonadotropin-releasing hormone (GnRH) antagonist, namely, degarelix. Degarelix was helpful for both diagnosis and treatment of symptoms. We highlight its potential role in diagnosis and medical management, particularly as an option for patients who are unwilling or unable to undergo immediate surgery. We also hypothesize that a fall in total testosterone following GnRH antagonist injection may indicate that an ovarian tumor is benign.
Date Issued
2026-06-01
Date Acceptance
2026-03-16
Citation
JCEM Case Reports, 2026, 4 (6)
ISSN
2755-1520
Publisher
Oxford University Press
Journal / Book Title
JCEM Case Reports
Volume
4
Issue
6
Copyright Statement
© The Author(s) 2026. Published by Oxford University Press on behalf of the Endocrine Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. See the journal About page for additional terms.
License URL
Identifier
10.1210/jcemcr/luag087
Subjects
hyperthecosis
hyperandrogenism
androgen-secreting ovarian tumors
hirsutism
GnRH antagonist
Publication Status
Published
Article Number
luag087
Date Publish Online
2026-05-06