Dexamethasone suppression test versus selective ovarian and adrenal vein catheterization in identifying virilizing tumors in postmenopausal hyperandrogenism – a systematic review and meta-analysis

Tng, Eng Loon; Tan, Jeanne M.M.

doi:10.1080/09513590.2021.1897099

Cited by 3 publications

(2 citation statements)

References 58 publications

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“…However, success rates are poor, and this invasive method carries potential risks. A recent systematic review and meta-analysis concluded that there is limited evidence for the use of selective venous sampling in identifying androgen-producing tumors in postmenopausal women ( 84 ).…”

Section: Discussionmentioning

confidence: 99%

Approach to Investigation of Hyperandrogenism in a Postmenopausal Woman

Hirschberg

2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Postmenopausal hyperandrogenism is a condition caused by relative or absolute androgen excess originating from the ovaries and/or the adrenal glands. Hirsutism, i.e., increased terminal hair growth in androgen-dependent areas of the body, is considered the most effective measure of hyperandrogenism in women. Other symptoms can be acne and androgenic alopecia or the development of virilization including clitoromegaly. Postmenopausal hyperandrogenism may also be associated with metabolic disorders like abdominal obesity, insulin resistance and type 2 diabetes. Mild hyperandrogenic symptoms can be due to relative androgen excess associated with menopausal transition or polycystic ovary syndrome, which is likely the most common cause of postmenopausal hyperandrogenism. Virilizing symptoms, on the other hand, can be caused by ovarian hyperthecosis or an androgen-producing ovarian or adrenal tumor that may be potentially malignant. Determination of serum testosterone, preferably by tandem mass spectrometry, is the first step in the endocrine evaluation providing important information on the degree of androgen excess. Testosterone > 5 nmol/L is associated with virilization and requires prompt investigation to rule out an androgen-producing tumor in first instance. To localize the source of androgen excess, imaging techniques are used like transvaginal ultrasound or magnetic resonance imaging (MRI) for the ovaries and computed tomography (CT) and MRI for the adrenals. Bilateral oophorectomy or surgical removal of an adrenal tumor is the main curative treatment and will ultimately lead to a histopathological diagnosis. Mild to moderate symptoms of androgen excess are treated with anti-androgen therapy or specific endocrine therapy depending on diagnosis. This review summarizes the most relevant causes of hyperandrogenism in postmenopausal women and suggests principles for clinical investigation and treatment.

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Section: Discussionmentioning

confidence: 99%

Approach to Investigation of Hyperandrogenism in a Postmenopausal Woman

Hirschberg

2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…Adrenal and ovary vein sampling could be considered to locate the source of excess androgen. However, there were only limited reports from studies with small sample size (19,(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). A study involving 38 patients with HA showed that the successful catheterization rate of the four veins (bilateral AVs and ovary veins (OVs)) was 27%, and the failure rate of OV catheterization was higher than AV catheterization.…”

Section: Hyperandrogenismmentioning

confidence: 99%

Recent Advances in the Clinical Application of Adrenal Vein Sampling

Zhong

Zhang

et al. 2022

Front. Endocrinol.

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We reviewed clinical research investigating the applications of adrenal vein sampling (AVS). AVS could be applied not only to primary aldosteronism (PA) but also to other endocrine diseases, such as adrenocorticotropic hormone (ACTH) independent Cushing syndrome (AICS) and hyperandrogenemia (HA). However, the AVS protocol requires improvements to increase its success rate. Using the computed tomography image fusion, coaxial guidewire technique, and fast intraprocedural cortisol testing (CCF) technique could improve the success rate of catheterization in AVS for PA. ACTH loading could be considered in medical centers with a low selectivity of AVS for PA but is not essential in those with mature AVS technology. The continuous infusion method should be recommended for ACTH stimulation in AVS for PA to reduce adverse events. AVS has not been routinely recommended before management decisions in AICS, but several studies verified that AVS was useful in finding out the source of excess cortisol, especially for distinguishing unilateral from bilateral disease. However, it is necessary to reassess the results of AVS in AICS with the use of reference hormones to fully normalize cortisol levels. In addition, it is essential to determine the optimal model that combines AVS results and mass size to guide the selection of surgical plans, including identifying the dominant gland and presenting the option of staged adrenalectomy, to minimize the impact of bilateral resection. For HA, AVS combined with ovarian intravenous sampling to locate excess androgens could be considered when imaging results are equivocal.

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Postmenopausal onset of androgen excess: a diagnostic and therapeutic algorithm based on extensive clinical experience

Luque-Ramírez,

Nattero-Chávez,

Rodríguez-Rubio Corona

et al. 2024

J Endocrinol Invest

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Purpose Postmenopausal hyperandrogenism is a rare condition that requires identifying those women bearing a life-threatening tumor. We aimed to study diagnostic work-up and management of postmenopausal androgen excess, proposing an algorithm for clinical decision supporting. Methods 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 (AUCROC), and 95% confidence intervals (95%CI), for distinguishing between benign and malignant conditions, and androgen excess source. Results Most commonly, postmenopausal hyperandrogenism derived from benign conditions such as ovarian hyperthecosis (n = 9). However, four (8%) patients had borderline/malignant tumors arising at the ovaries (n = 3) or adrenals (n = 1). 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 [AUCROC(95%CI): 0.899 (0.795; 1.000)] and estradiol [AUCROC(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. Conclusions 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.

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Dexamethasone suppression test versus selective ovarian and adrenal vein catheterization in identifying virilizing tumors in postmenopausal hyperandrogenism – a systematic review and meta-analysis

Cited by 3 publications

References 58 publications

Approach to Investigation of Hyperandrogenism in a Postmenopausal Woman

Approach to Investigation of Hyperandrogenism in a Postmenopausal Woman

Recent Advances in the Clinical Application of Adrenal Vein Sampling

Postmenopausal onset of androgen excess: a diagnostic and therapeutic algorithm based on extensive clinical experience

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