Tumor Level Testosterone Levels Detected in HIV+ Patient with Lipodystrophy

Background: Antiretroviral medications used to combat HIV progression can produce the side effect of lipodystrophy which can lead to the complication of hyperandrogenism in women. Case Presentation: A 25-year-old, nulliparous, HIV+, African American female presented to the Reproductive Endocrinology clinic complaining of oligomenorrhea and failure to conceive. The patient had been HIV+ since birth and managing her disease with the antiretroviral Norvir (Ritonavir). Laboratory evaluations for the patient's menstrual irregularity demonstrated testosterone levels in the range of 300 ng/dl and imaging showed a 2.2 cm possibly hemorrhagic left ovarian cyst, and 4.4 cm right ovarian cyst. In order to rule out cystic tumor growth as an explanation for the patient's elevated testosterone levels, a bilateral ovarian wedge resection was conducted, and pathology result showed no cancerous growths. Despite this finding, the testosterone levels diminished to the normal range for a few months after the procedure before rising again to the range of 150 ng/dl. In order to rule out PCOS caused by insulin resistance due to the patient's HIV medication targeting her ovarian cysts, the patient underwent a bilateral ovarian cystectomy. After her surgery, the patient's testosterone levels dropped to 46.55 ng/dl, but 7 months later, rose again to 171.09 ng/dl. At this point, it was accepted that the patient's medication-induced lipodystrophy was the instigating factor behind her elevated testosterone levels. Conclusion: This case illustrates the unique presentation of tumor level testosterone readings in a female patient as a result of lipodystrophy caused by her HIV medications.