Hypersecretion of ovarian androgens may be gonadotrophin dependent many years after menopause

Lindgren, R.; Gunnarsson, Cecilia; Jakobsson, Anna; Hammar, Mats

doi:10.1016/s0378-5122(99)00092-4

Cited by 11 publications

(5 citation statements)

References 15 publications

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“…The main non-tumoral cause of postmenopausal ovarian biochemical hyperandrogenism seems to be ovarian hyperthecosis (9). This typically bilateral condition is characterized by a hyperplastic ovarian stroma associated with cellular luteinization and is believed to result from abnormal ovarian steroidogenesis secondary to gonadotropic stromal hyperstimulation (10)(11)(12)(13). It is classically associated with insulin resistance and hyperinsulinemia in almost all reported cases (12,14,15), but, in contrast to polycystic ovary syndrome, the mechanisms correlating hyperinsulinemia and hyperthecosis remain unstudied (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Impact of clinical, hormonal, radiological, and immunohistochemical studies on the diagnosis of postmenopausal hyperandrogenism

Sarfati

Bachelot

Coussieu

et al. 2011

European Journal of Endocrinology

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Objective: Evaluation of postmenopausal women with suspicion of androgen-secreting tumor. Design and patients: We retrospectively studied 22 postmenopausal women referred to our center for suspicion of androgen-secreting tumor. All patients had clinical, biological, and morphological evaluation. In absence of adrenal tumors, ovarian surgery was most often proposed and immunohistochemistry (IHC) studies were performed. Results: Ovarian tumors were detected by ultrasound and/or magnetic resonance imaging in eight patients. Two adrenal androgen-secreting tumors were diagnosed by an adrenal computed tomography (CT) scan. The clinical presentation of the women with or without tumors was similar. Nevertheless, women with tumor exhibited significantly higher testosterone levels and lower basal FSH and LH levels than the other women (2.6G2.7 vs 0.9G0.9 ng/ml, P!0.05; 26.5G22.9 vs 66.5G 26.0 IU/l, P!0.01; and 12.0G8.6 vs 24.1G8.9 IU/l, P!0.05 respectively). Based on a likelihood ratio test, patients with a tumor had 8.4 and 10.8 times higher risk of having a testosterone level R1.4 ng/ml or an FSH level %35 IU/l. Finally, IHC analysis with an anti-P450c17a antibody allowed the identification of an elevated number of ovarian androgen-producing cells in five patients in whom no tumor was found. Conclusions: Androgen-secreting tumors are clinically difficult to discriminate from other causes of postmenopausal hyperandrogenism. Testosterone and FSH were the two discriminative markers in a multivariate analysis. Ovarian and adrenal tumors were detected by imaging studies. However, ovarian non-tumoral causes of hyperandrogenism may be difficult to detect with conventional histology.

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Section: Introductionmentioning

confidence: 99%

Impact of clinical, hormonal, radiological, and immunohistochemical studies on the diagnosis of postmenopausal hyperandrogenism

Sarfati

Bachelot

Coussieu

et al. 2011

European Journal of Endocrinology

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“…Of note, some ovarian [2, 11, 16, 17, 26, 29–31] and adrenal [18] testosterone-producing tumors are reported to be gonadotropin-responsive. This is supported by evidence that administering a GnRH agonist or antagonist in these cases can markedly decrease testosterone levels.…”

Section: Discussionmentioning

confidence: 99%

Hyperandrogenism in menopause: a case report and literature review

Dolinko

Ginsburg

2015

Fertil Res and Pract

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Hyperandrogenism is an uncommon diagnosis in postmenopausal women. In this case, we report on a 69-year-old postmenopausal woman who presented with several months of worsening hirsutism of the face, neck, and chin, which was confirmed on examination. Laboratory testing revealed markedly elevated testosterone levels and typical post-menopausal gonadotropin levels. Transvaginal ultrasonography and pelvic and abdominal magnetic resonance imaging (MRI) failed to reveal an ovarian or adrenal abnormality. The patient was a poor surgical candidate and was counseled to start on gonadotropin releasing hormone (GnRH) agonist therapy. Administration of leuprolide resulted in a dramatic decline in testosterone levels. The patient reported significant “hot flashes”, difficulty sleeping, anxiety, and depression secondary to treatment, and patient discontinued leuprolide therapy 3 months after initiation. To our knowledge, this is the first case that describes a woman being treated with a GnRH agonist for hyperandrogenism subsequently discontinuing GnRH agonist treatment due to significant side-effects. This case also highlights the difficulty of prescribing appropriate but off-label use of expensive medications not covered by insurance in a senior population of limited income.

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“…Although the exact aetiology is unclear, some authors claım that hyperthecosis ın postmenopausel women originate from elevated gonodotrophin productions. Patients with hyperthecosis typically have normal serum dehydroepiandrosterone sulfate (DHEA sulfate) concentrations [ 22 , 23 ]. Ultrasonography in women with hyperthecosis usually shows a bilateral increase in ovarian stroma and the ovaries appear more solid [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

An Interesting Cause of Hyperandrogenemic Hirsutism

Atmaca

Seven

Üçler

et al. 2014

Case Reports in Endocrinology

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Mild clinical signs of hyperandrogenism such as hirsutism may appear during the menopausal transition as part of the normal aging process, but the development of frank virilization suggests a specific source of androgen excess. We report a case of a 68-year-old woman with signs of virilization that had started 6 months before. Clinical analyses revealed high levels of serum testosterone for a postmenopausal woman. Pelvic MRI and abdomen CT showed no evidence of ovarian and adrenal tumor. Postmenopausal hyperandrogenism can be the result of numerous etiologies ranging from normal physiologic changes to ovarian or rarely adrenal tumors. Our patient was found to have iatrogenic hyperandrogenism. This condition is rarely reported cause of virilization.

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Hypersecretion of ovarian androgens may be gonadotrophin dependent many years after menopause

Cited by 11 publications

References 15 publications

Impact of clinical, hormonal, radiological, and immunohistochemical studies on the diagnosis of postmenopausal hyperandrogenism

Impact of clinical, hormonal, radiological, and immunohistochemical studies on the diagnosis of postmenopausal hyperandrogenism

Hyperandrogenism in menopause: a case report and literature review

An Interesting Cause of Hyperandrogenemic Hirsutism

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