Abstract
INTRODUCTION: Androgenetic alopecia (AGA) is a type of hair loss that often manifests as male or female pattern baldness. In women, AGA resembling male pattern baldness can occur in conditions of hyperandrogenism, such as congenital adrenal hyperplasia or ovarian and adrenal tumors, which are exceedingly rare, occurring in approximately 0.2% of cases. CASE PRESENTATION: We report a 62-year-old female exhibiting hair loss and hirsutism that began over a decade ago. The medical examination reveals hirsutism on the face, abdomen, and chest, and hair loss in the fronto-parieto-occipital region, with a male pattern distribution consistent with grade VII on the Hamilton scale. Trichoscopy revealed loss of follicular openings, single follicular units, miniaturized hairs, and perifollicular brown halo. Laboratory tests indicated a total testosterone level of 10.15 ng/mL. An abdominal CT scan revealed bilateral adrenal adenomas, which were subsequently treated with laparoscopic radical adrenalectomy. CONCLUSION: In postmenopausal women, a new-onset state of hyperandrogenism may lead to virilizing symptoms, such as male pattern alopecia, when testosterone levels exceed 5 nmol/L, necessitates immediate investigation to exclude an androgen-producing tumor, which typically normalizes swiftly within weeks post-surgery, while symptoms of androgen excess gradually diminish following the normalization of testosterone levels, as observed in our case. Identifying the cause of hyperandrogenism is crucial for treatment. Surgery remains the primary option for postmenopausal women with virilizing symptoms and androgen excess.