A Rare Case of Postmenopausal Hirsutism Associated With a Serous Cystadenofibroma of the Ovary.

Hirsutism in females is most commonly associated with polycystic ovarian syndrome, but can also result from congenital adrenal hyperplasia and ovarian tumors like granulosa cell tumors, Sertoli-Leydig cell tumors, and hilus cell tumors. We present a case of a 54-year-old female with hirsutism, diagnosed with ovarian cystadenofibroma. She had a history of premature ovarian failure at the age of 35 and presented with new onset chin and upper lip hair, and scalp hair loss. Labs showed elevated total testosterone, normal dehydroepiandrosterone (DHEA) and sex hormone-binding globulin (SHBG), low estradiol, and postmenopausal range anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. Cytogenetic testing showed a normal XX karyotype. Initial transvaginal ultrasound revealed a thickened endometrial stripe and unremarkable ovaries. Repeat ultrasound and MRI noted persistent endometrial thickening and a solid-cystic structure in the left ovary. The patient underwent total hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node dissection. Endometrial biopsy showed FIGO grade 1 endometrioid carcinoma, and the left ovary biopsy revealed benign serous cystadenofibroma and endometriosis. Postoperatively, hirsutism resolved and testosterone levels normalized. Hirsutism in postmenopausal women should prompt evaluation for adrenal or ovarian sources, including tumors. Ovarian tumors cause about 1% of hirsutism cases. Our case highlights the need for thorough evaluation, as benign ovarian tumors can also cause androgen excess and associated conditions like endometrial cancer.