Ovarian stromal hyperplasia: An uncommon cause of postmenopausal hyperandrogenism, case report and a brief review of literature

Ovarian stromal hyperplasia (OSH) is a non-neoplastic proliferation of ovarian stromal cells associated with hyperandrogenism. This condition mainly affects perimenopausal and postmenopausal women, making diagnosis challenging due to similar clinical symptoms. We present the case of a 61-year-old postmenopausal woman with progressive virilization, including hirsutism, voice deepening, and clitoromegaly. Biochemical evaluation revealed elevated serum testosterone with normal adrenal androgens, suggesting an ovarian origin. Subsequent cross-sectional imaging demonstrated bilateral ovarian enlargement without a distinctive mass, raising suspicion for a diffuse stromal process rather than a focal neoplasm. A gonadotropin-releasing hormone agonist trial was used as part of the diagnostic workup; ultimately, the patient underwent bilateral salpingo-oophorectomy. Histopathological examination demonstrated diffuse and nodular proliferation of luteinized stromal cells without cytologic atypia, consistent with ovarian stromal hyperplasia. Postoperatively, serum androgen levels were normalized, and the patient reported clinical improvement. This case emphasizes consideration of ovarian stromal hyperplasia in postmenopausal women who present with hyperandrogenism, particularly when laboratory findings suggest an ovarian source despite inconclusive imaging.