Ovarian and adrenal vein steroids in seven patients with androgen-secreting ovarian neoplasms: selective catheterization findings

Moltz, L.; Pickartz, H; Sörensen, R.; Schwartz, U.; Hammerstein, J.

doi:10.1016/s0015-0282(16)48143-4

Cited by 70 publications

(23 citation statements)

References 17 publications

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“…In addition, the serum levels of these androgens exceeded those reported by two series [2,3] on 16 cases with ovarian androgen-producing tumors. It is concluded that when OPG is elevated above the non-neoplastic range, the etiology cannot be assumed to be neoplastic until pathologically proven.…”

Section: Discussionmentioning

confidence: 53%

“…Selective retrograde venous catheterization has been used successfully in the past to localize both ovarian and adrenal neoplasms [2,3]. However, polycystic ovarian disease may mimic an ovarian neoplasm with elevated OPG on selective catheterization.…”

Section: Resultsmentioning

confidence: 99%

“…However, sensitivity of imaging techniques decreases with small tumors because these can be overlooked and reported as normal. In cases where imaging fails to give a positive result, selective retrograde venous catheterization is recommended to identify the affected organ, to direct surgical exploration later [2,3], thus minimizing tissue handling and injury to other organs. In an elaborate work, Moltz el al [2,4] calculated OPG in normal ovulating females, females with non-neoplastic hyperandrogenism, and patients with virilizing tumors.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Excessive Unilateral Ovarian Androgen Production

et al. 1993

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The diagnostic goal in severe hyperandrogenemia is to identify the source of excessive androgen production and to exclude the presence of a neoplasm. In cases with strong clinical suspicion of a neoplasm where ultrasound (US) and computerized tomography (CT) scan are normal, selective retrograde venous catheterization is currently recommended for tumor confirmation and localization. In the presented case, dynamic endocrine testing pointed toward androgen producing tumor. Ultrasound, CT scan, and magnetic resonance imaging (MRI) reported normal abdominal and pelvic organs. Retrograde venous catheterization showed a unilateral ovarian peripheral gradient above non-neoplastic range. Histopathology, however, showed the classical picture of the polycystic ovarian syndrome. Case ReportA 28-year-old female presented with a history of primary infertility for five years and increasing hirsutism for the same duration. She had oligoamenorrhea since her menarche at age 17 years of age. On examination, she was morbidly obese (body mass index 34) with severe hirsutism and a receding temporal hairline but no other signs of virilization. There were no cushingoid features. Basic endocrine workup on cycle day three showed evidence of severe hyperandrogenemia and elevated luteinizing hormone (LH) follicle-stimulating hormone (FSH) ratio (Table 1).The preoperative hormone levels are a mean of three samples tested to eliminate errors due to pulsatile secretion. The hormones were analyzed by radioimmunoassay using second antibody for separation (Pantax, Santa Monica, CA, USA) except for LH, FSH, prolactin, thyroid stimulating hormone, and thyroxine which were analyzed by enzyme immunoassay (Amerlite Diagnostics Ltd, Amersham, England).The adrenal steroid production was suppressed by dexamethasone 2 mg orally every six hours for two weeks. Serum testosterone (T) decreased from 44.3 to 24.7 ng/mL, suggesting partial suppression of androgen secretion. Buserelin 1000 μg/day subcutaneously was added for two weeks. Serum estradiol (E2) dropped from104 pg/ml to 25.0 pg/ml during this period. Serum T further dropped from 24.7 to 20.1 ng/mL. The above results raised the suspicion of androgen-producing tumor. Transvaginal US measured the right ovary as 31 mm and the left ovary as 30 mm in greatest diameter. The ovarian texture was normal. Computerized tomography of the abdomen and pelvis (4 mm continuous slices), showed normal adrenal glands in size and texture. There was no evidence of either polycystic ovaries or a circumscribed tumor. Magnetic resonance confirmed the same findings. Selective retrograde venous catheterization under fluoroscopic control was performed. Through a 6F introducing sheath inserted in the femoral vein, samples were obtained from ovarian and adrenal veins and the lower portion of the inferior vena cava; the results are shown in Table 2. On the basis of significantly elevated right ovarian peripheral gradient (OPG), right salpingo-oophorectomy was performed. Both tubes and ovaries looked unremarkable. The ovary was s...

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Section: Discussionmentioning

confidence: 53%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Case of Excessive Unilateral Ovarian Androgen Production

et al. 1993

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“…the differ ences in hormone levels between the streak gonadal and peripheral vein (SGPG) as well as the adrenal and peripheral vein (APG), were also determined. As Moltz et al [3] pointed out, the 'evaluation of cathe terization data restricted to the absolute effluent con centrations remains inconclusive and can be mislead ing'. For the calculation of the APG, the individual bilateral adrenal vein values were averaged.…”

Section: Methodsmentioning

confidence: 99%

“…The upper 95% confidence limit of the ovarian-peripheral gradient for testosterone is 0.21 ng/ml [5). Unilateral elevation of the ovarian-peripheral gradient for testosterone (> 2.7 ng/ml) is indicative of tumor development and justifies surgical exploration of the ovary [3].…”

Section: Methodsmentioning

confidence: 99%

Nonneoplastic Gonadal Testosterone Secretion as a Cause of Vaginal Cell Maturation in Streak Gonad Syndrome

Bösze¹,

Számel

Molnár

et al. 1986

Gynecol Obstet Invest

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Endocrine studies were carried out on 3 patients with streak gonad syndrome, 2 of whom had slight proliferative vaginal smear patterns, and the 3rd had slight hirsutism with increased muscle mass but an atrophic type vaginal smear pattern. Simultaneous sampling of peripheral, adrenal and streak gonadal venous blood revealed mildly increased testosterone secretion by the streaks in the 2 patients who had proliferative cytohormonal patterns. Histologic examination of their streak gonads showed hilus cell hyperplasia. It might be suggested that hilus cell hyperplasia was the source of the increased testosterone secretion in these 2 patients and thus resulted in slight maturation of the vaginal epithelium.

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