Introduction/Background Female hyperandrogenism is a common reason for consultation in endocrinology, gynecology, dermatology, or general medicine. It is defined by an excess of androgens. In women, both before and after menopause, the two sources of androgens are the ovaries and the adrenal glands. One of the main challenges in managing hyperandrogenism is identifying its origin and eliminating potential tumor-related causes. Although these causes are rare, they can still pose a potential threat. Androgenic ovarian tumors are an example of these uncommon causes, requiring specific management and follow-up.

Methodology Two cases of virilizing ovarian tumors diagnosed during the investigation of hyperandrogenism. The goal is to highlight the diagnostic and therapeutic peculiarities of these endocrine ovarian tumors, emphasizing the importance of early diagnosis, treatment, and long-term follow-up.

Results Observation 1. A 17-year-old patient presented with hirsutism and menometrorrhagia. Elevated testosterone levels, normal E2, normal SDHEA, plasma cortisol, and ACTH, suppressed FSH, and normal LH. Pelvic ultrasound revealed a right lateral uterine formation measuring 69 mm. She underwent conservative treatment, including right annexectomy and staging. Pathology results indicated a Sertoli-Leydig tumor.

Observation 2. A 57-year-old postmenopausal patient presented with hyperandrogenism. Elevated testosterone, non-elevated FSH and LH, normal E2, Delta 4 androstenedione, 17OHP, SDHEA, and plasma cortisol, and negative tumor markers (BHCG, alpha FP, CA125). Pelvic ultrasound showed a right lateral uterine mass measuring 46 mm. The patient underwent bilateral annexectomy and staging. Pathology results indicated a Leydig tumor.

Conclusion Hirsutism is relatively common, but pronounced virilization or hirsutism should trigger an etiological investigation as they may result from ovarian tumors. These tumors are rare and mostly benign. Their management is primarily surgical.

Disclosures The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report. The case studies and presentations were conducted with the patients‘ permission.