Hirsutism of Recent Onset with Marked Hyperandrogenaemia and Ovarian Hyperthecosis after the Menopause

Ayuk, Paul; Stringfellow, Helen F.; Donnai, P.; Beardwell, Colin G; Holt, Adrian; Laing, Ian

doi:10.1177/000456329803500123

Cited by 3 publications

(2 citation statements)

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“…Ovarian stromal hyperthecosis is usually associated with a long history of anovulation, amenorrhoea and of slowly, but relentlessly, progressing virilization. However, in peri-menopausal and reproductive age women symptoms of hyperthecosis may be of rapid onset whilst androgen-producing tumors characteristically cause rapidly progressing signs of androgen excess [2,5,6,8]. With all androgen-producing ovarian tumors, serum testosterone is elevated in conjunction with normal or mildly elevated serum DHEAS levels.…”

Section: Discussionmentioning

confidence: 99%

“…Bilateral ovarian stromal hyperthecosis is being increasingly recognized as a cause of significant hyperandrogenaemia in perimenopausal women. This is frequently accompanied by marked insulin resistance with other florid features of the metabolic syndrome which include hypertension, obesity, low HDL cholesterol and high triglycerides [5,6]. Such patients are at greatly increased risk for cardiovascular events particularly when coronary heart disease is established.…”

Section: Introductionmentioning

confidence: 99%

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

Nardo

Ray²,

Laing³

et al. 2005

Gynecological Endocrinology

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The authors report a case of Leydig cell tumor in a 46-year-old woman who first presented with severe clinical hyperandrogenism and associated complex medical history. Investigations revealed markedly raised serum concentrations of testosterone (28.3 nmol/l) and free androgen index (54.4), whereas sex hormone binding globulin, random cortisol, androstenedione, 17-hydroxyprogesterone and dehydroepiandrosterone sulphate concentrations were all within the normal range. Transabdominal ultrasound and computed tomography scan of the pelvis and abdomen showed a slightly bulky right ovary, but no other abnormalities. An ovarian source of androgens was suspected and surgery was arranged. Following a three-year history of defaulting appointments due to agoraphobia, she underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and intraoperative selective ovarian venous sampling. Histopathological examination revealed a 2 cm Leydig cell tumor within the right ovary. Successful intraoperative ovarian venous sampling demonstrated significantly elevated testosterone levels (>260 nmol/l) from the right ovarian vein. Hyperandrogenaemia normalized post-operatively. The patient showed significant regression of clinical signs and symptoms, including the anxiety disorder. Clinical presentation, biochemistry and imaging modalities should allow to detect androgen-secreting ovarian tumors, while selective venous sampling should be reserved for patients whom uncertainty remains. The present case confirms that androgen-secreting ovarian tumors represent a diagnostic and therapeutic challenge. They have to be considered in the differential diagnosis of severe hyperandrogenism even in peri-menopausal women. Although selective venous sampling is of diagnostic value, however, its impact on future management should be considered on individual basis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%