Gonadotropin-Releasing Hormone Analogue Stimulation Test Versus Venous Sampling in Postmenopausal Hyperandrogenism

Tng, Eng Loon; Tan, Jeanne May May

doi:10.1210/jendso/bvaa172

Cited by 4 publications

(3 citation statements)

References 66 publications

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“…Testosterone above 64 ng/dL defines pathologic postmenopausal hyperandrogenism [ 2 ]. Algorithms based on hormone levels, most commonly testosterone and DHEAS, imaging findings, or response to dexamethasone or gonadotropin-releasing hormone (GnRH) have been reported [ 3 , 6 , 8 , 9 ]. Tumorous testosterone levels are typically over 144 ng/dL (5 nM) to 150 ng/dL, as seen in our patient [ 2 , 3 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Incomplete dexamethasone-induced suppression of cortisol and androstenedione and no change in testosterone were suggestive of ovarian source in our patient. Given the presence of adrenal mass and normal-appearing ovaries, ovarian and adrenal vein sampling sought to discriminate between adrenal or ovarian location and its laterality [ 4 , 6 , 7 , 9 ]. The mean ovarian-to-vena cava testosterone effluent was much greater than that of the adrenal (4,019 ovarian and 267 adrenal), supporting an ovarian source.…”

Section: Discussionmentioning

confidence: 99%

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Postmenopausal Hyperandrogenism Associated With Synchronous Ovarian Brenner Tumor, Bilateral Leydig Cell Tumor, and Adrenal Mass

Salim,

Dasaraju,

Erickson

et al. 2024

Cureus

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Hyperandrogenism in postmenopausal females may arise from either ovarian or adrenal sources and can pose a challenging diagnostic dilemma. We present the case of a 66-year-old female with postmenopausal hyperandrogenism with virilization, adrenal incidentaloma, and concurrent finding of two extremely rare ovarian tumors, including bilateral Leydig cell tumor and Brenner tumor. Laboratory tests showed elevated testosterone and androstenedione and normal dehydroepiandrosterone sulfate (DHEAS). Response to 1 mg overnight dexamethasone suppression test demonstrated persistently elevated testosterone and incomplete suppression of androstenedione. Computed tomography (CT) scan showed a left adrenal nodule and an unremarkable appearance of the ovaries. The pelvic ultrasound did not show an ovarian tumor on the right ovary, and the left ovary was not seen. Adrenal and ovarian vein sampling suggested the ovaries as the source of the testosterone. Given the ovarian vein sampling results, a multidisciplinary discussion between endocrinology and gynecologic oncology concluded that bilateral salpingo-oophorectomy (BSO) was the next best step for diagnosis and management. Laparoscopic BSO was performed. Histopathology showed bilateral Leydig cell tumors and a left ovarian Brenner tumor. At one-year postoperative follow-up, alopecia improved, and testosterone level normalized. This case highlights the importance of diagnostic pathways and interdisciplinary collaboration in managing rare clinical scenarios of hyperandrogenism in postmenopausal females. As in our case, surgeons may be hesitant to remove normal-appearing ovaries. While the three presented tumor types in this case arise from distinct tissues and exhibit different histological characteristics, the presence of such a unique triad prompts consideration of potential unifying pathogenic mechanisms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Postmenopausal Hyperandrogenism Associated With Synchronous Ovarian Brenner Tumor, Bilateral Leydig Cell Tumor, and Adrenal Mass

Salim,

Dasaraju,

Erickson

et al. 2024

Cureus

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“…Pelvic magnetic resonance imaging has been reported as the best radiological discriminator between VOT and OHT by identifying a unilateral ovarian nodule, although positron emission tomography scan may also have some further diagnostic utility. However, imaging is often nondiagnostic as many VOTs can be less than 1 cm in size 76 …”

Section: Diagnostic Work‐upmentioning

confidence: 99%

Approach to androgen excess in women: Clinical and biochemical insights

Cussen

McDonnell

Bennett

et al. 2022

Clinical Endocrinology

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Androgen excess in women typically presents clinically with hirsutism, acne or androgenic alopecia. In the vast majority of cases, the underlying aetiology is polycystic ovary syndrome (PCOS), a common chronic condition that affects up to 10% of all women. Identification of women with non-PCOS pathology within large cohorts of patients presenting with androgen excess represents a diagnostic challenge for the endocrinologist, and rare pathology including nonclassic congenital adrenal hyperplasia, severe insulin resistance syndromes, Cushing's disease or androgen-secreting tumours of the ovary or adrenal gland may be missed in the absence of a pragmatic screening approach. Detailed clinical history, physical examination and biochemical phenotyping are critical in risk-stratifying women who are at the highest risk of non-PCOS disorders. Red flag features such as rapid onset symptoms, overt virilization, postmenopausal onset or severe biochemical disturbances should prompt investigations for underlying neoplastic pathology, including dynamic testing and imaging where appropriate. This review will outline a proposed diagnostic approach to androgen excess in women, including an introduction to androgen metabolism and provision of a suggested algorithmic strategy to identify non-PCOS pathology according to clinical and biochemical phenotype.

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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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Gonadotropin-Releasing Hormone Analogue Stimulation Test Versus Venous Sampling in Postmenopausal Hyperandrogenism

Cited by 4 publications

References 66 publications

Postmenopausal Hyperandrogenism Associated With Synchronous Ovarian Brenner Tumor, Bilateral Leydig Cell Tumor, and Adrenal Mass

Postmenopausal Hyperandrogenism Associated With Synchronous Ovarian Brenner Tumor, Bilateral Leydig Cell Tumor, and Adrenal Mass

Approach to androgen excess in women: Clinical and biochemical insights

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

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