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We aimed to study diagnostic work-up and management of postmenopausal androgen excess, proposing an algorithm for clinical decision supporting.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted an observational cross-sectional study and longitudinal follow-up including 51 consecutive menopausal patients reported for hyperandrogenism between 2003 and 2023 to our clinics. We assessed diagnostic testing accuracy and performance by receiver operating characteristic curves, their respective areas under the curve (AUC<jats:sub>ROC<\/jats:sub>), and 95% confidence intervals (95%CI), for distinguishing between benign and malignant conditions, and androgen excess source.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Most commonly, postmenopausal hyperandrogenism derived from benign conditions such as ovarian hyperthecosis (<jats:italic>n<\/jats:italic>\u2009=\u20099). However, four (8%) patients had borderline\/malignant tumors arising at the ovaries (<jats:italic>n<\/jats:italic>\u2009=\u20093) or adrenals (<jats:italic>n<\/jats:italic>\u2009=\u20091). These latter were more likely to develop virilization than those with benign disorders [specificity(95%CI)]: 0.87 (0.69; 0.92)]. Circulating total testosterone [AUC<jats:sub>ROC<\/jats:sub>(95%CI): 0.899 (0.795; 1.000)] and estradiol [AUC<jats:sub>ROC<\/jats:sub>(95%CI): 0.912 (0.812; 1.000)] concentrations showed good performances for discriminating between both conditions. Transvaginal-ultrasonography found two out of three potentially malignant ovarian neoplasms, and another was apparent on a pelvic computed tomography scan. An adrenal computed tomography scan also located an androgen-secreting carcinoma.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Clinical or biochemical features of an aggressive androgen-secreting tumor should lead to urgently obtaining a targeted imaging. At first, an abdominal-pelvic CT scan represents the best choice to perceive adrenal malignancy, and may identify aggressive ovarian tumors. When warning signs are lacking, a calm and orderly work-up allows properly addressing the diagnostic challenge of postmenopausal hyperandrogenism.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s40618-023-02297-9","type":"journal-article","created":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T11:02:37Z","timestamp":1707822157000},"page":"2007-2020","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Postmenopausal onset of androgen excess: a diagnostic and therapeutic algorithm based on extensive clinical experience"],"prefix":"10.1007","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6002-4237","authenticated-orcid":false,"given":"M.","family":"Luque-Ram\u00edrez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Nattero-Ch\u00e1vez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Rodr\u00edguez-Rubio Corona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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We obtained Institutional Review Board approval for this research database and clinical study from the local Ethics Committee of Hospital Universitario Ram\u00f3n y Cajal (Date of approval: May 12 2023; Reference number: 123\/23).\u00a0","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and\/or animals"}},{"value":"The local Institutional Review Board waived the requirements to obtain informed consent from the study subjects taking into account that all the data used in the study were retrospectively retrieved, the study did not have any risk for the study subjects, the study did not\u00a0affect the rights and\u00a0welfare of the subjects, no identifiable personal data would\u00a0be exposed, and the research could have\u00a0not been practicably carried out without the waiver.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}