Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women?

Kaltsas, Gregory; Mukherjee, J. J.; Kola, Blerina; Isidori, Andrea M.; Hanson, J.; Dacie, Janet E.; Reznek, Rodney H.; Monson, John P.; Grossman, Ashley

doi:10.1046/j.1365-2265.2003.01792.x

Cited by 115 publications

(75 citation statements)

References 39 publications

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“…polycystic ovarian syndrome, hyperthecosis, Cushing's syndrome, congenital adrenal hyperplasia, and iatrogenesis (see for review (1)). Symptoms of androgen excess are associated with a tumoral pathology in !1% of women of all ages (2)(3)(4)(5). Androgen-producing ovarian tumors include lipoid, Leydig cell, granulosa-theca cell, and Sertoli-stromal cell tumors (6,7).…”

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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“…It has been suggested that ovarian and adrenal venous catheterization and sampling not be performed routinely in women presenting with symptoms and signs of hyperandrogenism; venous catheterization and sampling should be reserved for patients in whom uncertainty remains [8]. We omitted ovarian vein blood sampling, since ovarian tumor had been diagnosed with transvaginal sonography preoperatively.…”

Section: Discussionmentioning

confidence: 99%

An ovarian steroid cell tumor with virilization and hypothyroidism: a case report

Wang

Chen

et al. 2007

Gynecol Surg

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Steroid cell tumors are rare ovarian sex-cord stromal tumors with malignant potential. The majority of these tumors produce steroids with testosterone being the most common. The diagnosis of these rare tumors can be problematic especially in the case of a small nonpalpable ovarian tumor. A 41-year-old woman presented with the gradual onset of defeminization, mild hypothyroidism, and virilization. A physical examination revealed a relatively healthy woman with borderline hirsutism, clitoromegaly and adnexal fullness without a palpable tumor. Elevated serum levels of TSH and testosterone were found preoperatively. Five weeks after an oophorectomy, serum levels of TSH and testosterone returned to normal and menstruation returned. Nonpalpable virilizing ovarian steroid cell tumors may be difficult to diagnose. A careful study of the patient's history, the development of defeminization followed by virilization, and a "characteristic" ultrasonogram, can be helpful for diagnosis. Hormonal studies including thyroid function should also be considered in an ovarian steroid cell tumor.

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“…Some researchers favor the use of SVCHS, but also point out its low feasibility, the need for expertise and the high failure rate of catheterization as drawbacks. SVCHS is not recommended to be performed routinely for the investigation of hyperandrogenic women but in the presence of a small ovarian tumor when all endocrinologic studies and imaging results fail, it should be kept in mind as a last resort for definitive diagnosis [4].…”

Section: Discussionmentioning

confidence: 99%

“…Although transvaginal ultrasound, computed tomography or magnetic resonance imaging (MRI) might sometimes demonstrate a tumor, a small lesion of less than 2 cm is usually difficult to be detected [4]. Selective venous catheterization and hormonal sampling (SVCHS) of at least four venous vessels (bilateral ovarian-adrenal veins) might help to confirm the presence of an androgen producing tumor either in the ovary or adrenal gland and its laterality [5].…”

Section: Introductionmentioning

confidence: 99%

A case of postmenopausal ovarian hyperandrogenemia diagnosed only by selective catheterization of ovarian vein

Uğurel¹,

Aslan²,

Elter³

2018

Journal of Surgery and Medicine

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Hyperandrogenemia in a postmenopausal woman is usually related to a tumor in either ovaries or adrenal glands. To differentiate between these two endocrine organs is a diagnostic challenge when the tumor size is too small to be detected with the aid of usual imaging modalities. 54 years-old postmenopausal woman with signs of virilization was referred to our institution with serum total testosterone levels of 294 ng/dl. Contrast-enhanced computed tomography (CT) revealed a lesion consistent with the tumor 1 cm in diameter in the adrenal gland and magnetic resonance imaging (MRI) could not confirm this finding. The location of androgen hypersecretion could only be determined after selective venous catheterization and hormonal sampling of both adrenal and ovarian veins. The right ovarian venous total testosterone level was found as > 1009.40 ng / dl. A right-sided ovarian Leydig cell tumor was diagnosed in the specimen of laparoscopic hysterectomy and bilateral salpingo-oopherectomy. This case report underlines the importance to carry on the search with the selective venous catheterization and hormonal sampling from both the ovarian and the adrenal veins when there is difficulty to demonstrate the true source of androgen hypersecretion in a postmenopausal woman. Keywords: Postmenopause, Hyperandrogenism, Ovarian Neoplasms, Leydig cell tumor, Selective venous catheterization Öz Postmenapozal dönemde hiperandrojenemi genellikle over veya adrenal bezlerdeki tümörlerle ilişkilidir. Her iki endokrin organdaki tümörlerin çapları çok küçük olduğunda görüntüleme yöntemleri tanıda yetersiz kalmaktadır. 54 yaşında postmenapozal hasta, klitoromegali ve artış gösteren hirsutizm bulguları olan hasta serum total testosteron seviyesi 294 ng/dl ile bölümümüze başvurdu. Kontrastlı bilgisayarlı tomografide (BT) adrenal bezde 1 cm çapında tümör ile uyumlu lezyon saptandı ancak manyetik rezonans (MR) ile bu bulgu teyit edilemedi. Androjen hipersekresyonunun orijininin tespit edilememesi üzerine bilateral ovaryen ve adrenal venlerin selektif venöz kateterizasyonu ve hormonal örneklemesi yapıldı. Sağ ovaryan ven total testosteron düzeyi >1009,40 ng/dl olarak bulundu. Laparoskopik histerektomi ve bilateral salpingooferektomi yapılan hastanın patoloji sonucu sağ over kaynaklı Leydin Hücreli Tümör olarak geldi. Bu olgu sunumunda, postmenopozal bir kadında androjen hipersekresyonu kaynağını bulunamadığında , hem ovaryen venden hem de adrenal venlerden selektif venöz kateterizasyon ve hormonal örnekleme yapmanın önemi vurgulanmaktadır.

show abstract

Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women?

Cited by 115 publications

References 39 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

An ovarian steroid cell tumor with virilization and hypothyroidism: a case report

A case of postmenopausal ovarian hyperandrogenemia diagnosed only by selective catheterization of ovarian vein

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