Discriminating between virilizing ovary tumors and ovary hyperthecosis in postmenopausal women: clinical data, hormonal profiles and image studies

Yance, Viviane Dos Reis Vieira; Marcondes, José Antônio Miguel; Rocha, Marco; Barcellos, Cristiano Roberto Grimaldi; Dantas, Wagner Silva; Avila, Ana Flavia Assis; Baroni, Ronaldo Hueb; Carvalho, Filomena Marino; Hayashida, Sylvia Asaka Yamashita; Mendonça, Berenice Bilharinho; Domenice, Sorahia

doi:10.1530/eje-17-0111

Cited by 39 publications

(41 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the study by Yance et al . (12) demonstrated best discriminating FSH level as 22.3 mIU/mL but again compromising the sensitivity to 77%. Use of this cut-off would have missed both of our patients.…”

Section: Discussionmentioning

confidence: 93%

“…Study done by Hai Yan Zhang found that the median level of testosterone concentration was as high as 9.75 ± 6.86 ng/mL (range 3.6–21.9 ng/mL) before excision of VOT and reduced to normal level with in the 10 days after the surgery (11). Although lower serum total testosterone cut-offs (1.0–1.4 ng/mL) (12) have been suggested to differentiate OH and VOT in postmenopausal women, a recent study by Yance et al . questioned diagnostic accuracy of these cut-offs.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Virilising ovarian tumors: a single-center experience

Sehemby

Bansal

Sarathi

et al. 2018

Endocrine Connections

View full text Add to dashboard Cite

Literature on virilising ovarian tumors (VOTs) is limited to case reports and series reporting single pathological type. We have analyzed the clinical, hormonal, radiological, histological, management and outcome data of VOT. This retrospective study was conducted at a tertiary health care center from Western India. Consecutive patients with VOT presenting to our endocrine center between 2002 and 2017 were included. Our study included 13 patients of VOT. Out of 13 patients, two were postmenopausal. All patients in the reproductive age group had secondary amenorrhea except one who presented with primary amenorrhea. Modified F and G score (mFG) at presentation was 24 ± 4.3 and all patients had severe hirsutism (mFG ≥15). Change in voice (n = 11) and clitoromegaly (n = 7) were the other most common virilising symptoms. Duration of symptoms varied from 4 to 48 months. Median serum total testosterone level at presentation was 5.6 ng/mL with severe hyperandrogenemia (serum testosterone ≥2 ng/mL) but unsuppressed gonadotropins in all patients. Transabdominal ultrasonography (TAS) detected VOT in all except one. Ten patients underwent unilateral salpingo-oophorectomy whereas three patients (peri- or postmenopausal) underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Seven patients had Sertoli Leydig cell tumor, three had steroid cell tumor and two had Leydig cell tumor and one had miscellaneous sex cord stromal tumor. All patients had normalization of serum testosterone after tumor excision. In conclusion, VOTs present with severe hyperandrogenism and hyperandrogenemia. Sertoli Leydig cell tumor is the most common histological subtype. Surgery is the treatment of choice with good surgical outcome.

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Virilising ovarian tumors: a single-center experience

Sehemby

Bansal

Sarathi

et al. 2018

Endocrine Connections

View full text Add to dashboard Cite

show abstract

“…Once an adrenal source of T excess has been ruled‐out, differentiating between OH and VOTs may be challenging. The initial plausible notion that patients with VOTs present with rapid virilization has not been substantiated so far . In a case‐control series, there was no significant difference in duration from onset of symptoms to diagnosis, ranging from 4 to 126 months, when comparing patients with OH and VOTs .…”

Section: Diagnostic Approach To Severe Postmenopausal Hyperandrogenismmentioning

confidence: 95%

“…The initial plausible notion that patients with VOTs present with rapid virilization has not been substantiated so far . In a case‐control series, there was no significant difference in duration from onset of symptoms to diagnosis, ranging from 4 to 126 months, when comparing patients with OH and VOTs . The only discriminatory virilizing signs between the 2 groups were deepening of the voice and muscular hypertrophy, ascertainment of which in clinical practice relies heavily on patients’ subjective assessment and, possibly, comparison of serial photographs.…”

Section: Diagnostic Approach To Severe Postmenopausal Hyperandrogenismmentioning

confidence: 99%

Clinical Case Seminar: Postmenopausal androgen excess–challenges in diagnostic work‐up and management of ovarian thecosis

Mamoojee

Ganguri

Taylor

et al. 2017

Clinical Endocrinology

View full text Add to dashboard Cite

SummaryPostmenopausal hyperandrogenism can be tumour-or non-tumour-related, with pathology residing either in the ovary or adrenal gland(s). The tempo of investigation is determined by the clinical severity of hyperandrogenism (presence/absence of actual virilisation) and degree of serum testosterone elevation. When clinical or biochemical hyperandrogenism is severe, rapidly developing, or associated with hypercortisolism, screening for adrenocortical or ovarian carcinoma with crosssectional imaging should be prioritised over detailed biochemical evaluation. Adrenal hyperandrogenism is readily characterised, both biochemically and radiologically. By contrast, even a combination of high-resolution imaging with laboratory evaluation, including dynamic endocrine testing, often cannot distinguish between ovarian hyperthecosis (OH) and virilising ovarian tumour (VOT); a definitive diagnosis usually emerging only after histological examination of excised ovaries. VOTs are typically below the resolution-limit of current imaging modalities and exhibit suppression of gonadotropin-dependent androgen secretion with GnRH-analogue therapy. Thus, for well-characterised ovarian hyperandrogenism, laparoscopic bilateral salpingo-oophorectomy may serve both as a diagnostic and therapeutic procedure. Nevertheless, women unable or unwilling to undergo ovarian surgery can be reassured that malignant VOTs are exceedingly rare and that long-term medical therapy with oral antiandrogens or GnRH-analogues is safe and well-tolerated. OH is strongly associated with insulin-resistance, with hyperinsulinaemia acting synergistically with raised gonadotropin levels to stimulate thecal cell hyperplasia and androgen secretion by the postmenopausal ovary, which lacks granulosa cell aromatase activity and thus cannot convert testosterone to 17 beta estradiol. Thus, features of metabolic syndrome may indicate OH, and significant reductions in androgens can thereby potentially be achieved with lifestyle measures and/or insulin-sensitising drugs. K E Y W O R D Shirsutes, management of ovarian hyper thecosis, post-menopausal androgen excess, virilisation testosterone

show abstract

“…Це стан, який характеризується лютеїнізацією строми яєчників, високими рівнями ЛГ, гіперінсулінемією та інсулінорезистентністю. Причини яєчникового гіпертекозу залишаються невідомими [47]. Провідна роль в його патогенезі належить високим рівням гонадотропінів, зокрема ЛГ, що призводить до гіперплазії стромальних яєчникових клітин.…”

Section: яєчниковий гіпертекоз (стромальний текоматоз яєчників)unclassified

Androgen synthesis in menopause and diagnosis of causes of hyperandrogenism in menopause

Бурка¹,

Тутченко²

2019

Reproductive Endocrinology

View full text Add to dashboard Cite

Discriminating between virilizing ovary tumors and ovary hyperthecosis in postmenopausal women: clinical data, hormonal profiles and image studies

Cited by 39 publications

References 41 publications

Virilising ovarian tumors: a single-center experience

Virilising ovarian tumors: a single-center experience

Clinical Case Seminar: Postmenopausal androgen excess–challenges in diagnostic work‐up and management of ovarian thecosis

Androgen synthesis in menopause and diagnosis of causes of hyperandrogenism in menopause

Contact Info

Product

Resources

About