Virilized

A 33 year old woman presents with progressive hair growth on her face and chest for 6 months, and irregular periods occurring every 2 to 3 months, for 5 months.

Prior to this, her menstrual periods occurred at regular 30 day cycles.

Her medical history is unremarkable and she is not on any medications.

Select Relevant Investigations
Hormone profile

Performed

TSH, Estrogen, Prolactin, Progesterone, DHEAS, 17-OH Progesterone: normal
Testosterone: 392 ng/dL (high)
48h low dose dexamethasone suppression test: cortisol & DHEAS suppressed; testosterone elevated
Ultrasound Abdomen & Pelvis

Performed

An abdominal and transvaginal ultrasound scan are performed. No abnormalities are detected.
CT Abdomen + Pelvis

Performed

The CT scan of the abdomen and pelvis shows no abnormalities.
Sampling of adrenal & ovarian veins

Performed

There are elevated testosterone concentrations in the right ovarian vein.

Select Relevant Management
R/S Oophorectomy
Dexamethasone
Antiandrogens
Pelvic radiotherapy