Although most data regarding the prevalence of virilization in females is amongst the adult population, adolescents can also experience hyperandrogenism or virilization. PCOS is the most common etiology; however, there is a broad differential for hyperandrogenism in the adolescent including idiopathic hirsutism, late onset congenital adrenal hyperplasia, adrenal and ovarian tumors.1

Ovarian tumors are rare in children and adolescents; however, the incidence increases with age. At one year of age the incidence of ovarian tumors is 0.43 in 100,000 patients and by thirty-five years of age the incidence is 152 in 100,000 patients.2 Leydig cell tumors are a subset of the sex cord-stromal group of ovarian tumors and account for less than 0.1% of all ovarian tumors across all age groups.2,3,4 Leydig cell tumors are known for secreting testosterone, therefore, patients will often present with hirsutism, deepening of the voice, clitoromegaly, increased muscle mass, and abnormal uterine bleeding.3

We describe the case of an adolescent female patient presenting with recurrent ovarian torsion and virilization who was diagnosed with an ovarian Leydig cell tumor. The purpose of this case report is to highlight clinical presentation of hyperandrogenism in an adolescent due to an atypical cause and discuss the challenges associated diagnosis and management of rare ovarian tumors.