Granulosa cell tumor resection with subsequent onset of rheumatoid arthritis

•Declining estrogen levels are associated with the onset of rheumatoid arthritis.•Granulosa cell tumors secrete estrogens leading to hyperestrogenism.•Rheumatoid arthritis has been associated with hypoestrogenism and menopause.•Removal of granulosa cell tumors may cause a steep decline in estrogen levels precipitating rheumatoid arthritis. Rheumatoid arthritis(RA)isan autoimmune disorder with an estrogen correlation. The disease can worsen or present with menopause.Granulosa cell tumors(GCT)are estrogen-secreting ovarian sex-cord stromal tumors with median incidence in the early postmenopausal years. We report a 38-year-old female who presented with a20 cm pelvic mass and elevated inhibin and underwent atotal abdominal hysterectomy with bilateralsalpingo-oophorectomy for a Stage I GCT. She developed progressive post-operativejoint pain and weakness before an eventual diagnosis of seropositiveRA.With tumor resection and surgical menopause,the patientexperienced an abrupt decline in estrogen levels precipitating the onset ofRAsymptoms. Prior research identified that hormone fluctuation at menopause correlates withonsetofRA. While unfortunately direct estrogen measurements were not obtained perioperatively, this case does support circumstantial evidence correlating RA with menopause and a decline in estrogen, irrespective of age.