The term hyperthecosis refers to the presence of nests of luteinized theca cells in the ovarian stroma due to differentiation of the ovarian interstitial cells into steroidogenically active luteinized stromal cells (picture 1). These nests or islands of luteinized theca cells are scattered throughout the stroma of the ovary, rather than being confined to areas around cystic follicles as in the polycystic ovary syndrome (PCOS). The result is greater production of androgens. The precise etiology of ovarian hyperthecosis is still unclear.
The clinical presentation, diagnosis, and treatment of ovarian hyperthecosis are discussed here. The clinical presentation and diagnosis of polycystic ovary syndrome are reviewed separately. (See "Clinical manifestations of polycystic ovary syndrome in adults" and "Diagnosis of polycystic ovary syndrome in adults".)
Ovarian hyperthecosis, a disorder characterized by severe hyperandrogenism and insulin resistance, is seen primarily in postmenopausal women [1-3]. Women typically present with slowly progressive acne and hirsutism (eg, excessive male pattern hair growth), and they are likely to be virilized . Thus, many have clitoral enlargement, male pattern baldness, deepening of the voice, and a male habitus.
In almost all cases, insulin resistance and hyperinsulinemia are present [3,5,6], and women are at increased risk for type 2 diabetes and cardiovascular disease . Additional physical findings may include central obesity, skin tags, and acanthosis nigricans.
The ovarian secretion of large amounts of androgens in women with hyperthecosis means that peripheral estrogen production is increased. As a result, the risk of endometrial hyperplasia and endometrial carcinoma is increased, especially in postmenopausal women [2,7].