An unusual steroid-producing ovarian tumour: Case report

Abstract

The rapid onset of virilization in a post-menopausal woman is usually the result of androgen secretion from a tumour of adrenal or ovarian origin. Androgen secreting neoplasms of the ovary are rare and usually show autonomous secretion. Rarely, these may be driven by the high levels of gonadotrophins seen in the post-menopausal state. We describe the case of a 67-year-old woman with high serum testosterone and estradiol in association with the high gonadotrophin levels usually associated with the post-menopausal state. All hormonal parameters showed a significant suppression over 12 h with administration of the GnRH antagonist, cetrorelix. This observation implies that excess hormone synthesis was of ovarian origin and was gonadotrophin driven. Localization of the tumour was not possible by conventional ultrasound or computerized tomography scanning, but was achieved by venous sampling. Complete cure was achieved by total abdominal hysterectomy and bilateral salpingo-oophorectomy, with restoration of the endocrine profile to that expected for a post-menopausal woman. Rapidly acting GnRH antagonists, such as cetrorelix, offer a safe and useful diagnostic and therapeutic option in the management of ovarian steroid-secreting tumours, which show gonadotrophin dependency.

Cetrorelix suppression test to assess the source of androgen overproduction in postmenopausal hirsutism

“…Therefore, the cetrorelix suppression test seems to be preferable as a diagnostic tool because maximal hormone suppression can be observed within several days. Our observations confirm and extend the report of Stephens et al (14), who described a similar case and documented the 24 h hormonal response to cetrorelix. Considering gonadal steroid half-lives and the biological variability in LH responsiveness of ovarian tumors, a 24 h cetrorelix suppression test is too short to achieve maximal suppression of the relevant androgens.…”

Ovarian Leydig cell tumor in a peri-menopausal woman with severe hyperandrogenism and virilization

“…During the last two decades, several authors have reported the role of selective ovarian and adrenal venous catheterization as investigation for hyperandrogenism [9,10,12,13]. A unilateral androgen gradient allows the localization of the lesion.…”

Hiperandrogenismo por tumor de Leydig do ovário produtor de testosterona

“…Os tumores do ovário associados a hiperandrogenismo incluem os tumores de células de Leydig, luteomas do estroma e tumores de células produtoras de esteroides não específicos 3,7 . Como já referido, os tumores produtores de androgénios podem ter também origem nas glândulas suprarrenais, embora estes sejam ainda mais raros 5,6 .…”