Ovarian hyperthecosis and response to antiandrogens: An uncommon presentation of a common disorder

Rajput, Rajesh; Bhansali, Anil; Singh, Rai

doi:10.1080/01443610801967075

Cited by 3 publications

(1 citation statement)

References 3 publications

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“…However, other studies have demonstrated that hyperandrogenemia results from the increased volume of stromal tissue itself rather than abnormal biochemical function of the ovary [11]. Some groups have shown that administration of a GnRH agonist can suppress circulating androgen levels, suggesting that OSH may not be autonomous, but instead may rely on gonadotropin secretion [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Ovarian Stromal Hyperthecosis and Hyperandrogenemia Refractory to Hormonal Suppression

Gressel¹

2015

Obstet Gynecol Cases Rev

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been menopausal since age 53 and for approximately 1 year, had noted undesired increased libido and hirsutism. Although she was not sexually active with her husband, she experienced frequent and unprovoked spontaneous orgasms. She also reported hair growth on her arms, shoulders, chin and upper lip as well as recession of her hairline and thinning of hair on her scalp. The patient's medical history was remarkable for recently diagnosed subclinical hyperthyroidism, osteoporosis, obesity, as well as Meniere's disease, hypertension and chronic obstructive pulmonary disease. She also had a long-standing history of type 2 diabetes mellitus on oral hypoglycemics with a baseline hemoglobin A1C value of 6.2%. Her obstetrical history was significant for 2 terms, uncomplicated vaginal deliveries. Her gynecologic history included late onset of menarche at the age of 16 and a history of life-long oligomenorrhea. Other than a twenty-pack year smoking history, she reported no other significant medical comorbidities.On evaluation, the patient was noted to have normal vital signs with a body mass index of 36.6 kg/m 2 . She appeared hirsute with facial and lower abdominal hair growth as well as male pattern alopecia. She also exhibited cervicodorsal protuberance ("buffalo hump") and clitoromegaly, above the upper limit for her age. Laboratory assessment demonstrated elevated free (12.0 pg/mL) and total (115 ng/dL) testosterone, but normal 17-hydroxyprogesterone (39 ng/dL), dehydroepiandrosterone (57 mcg/dL), and its sulfate (36 mcg/dL). Prolactin (10.6 ng/mL), estradiol (18 pg/mL), luteinizing hormone (43.1 mIU/mL) and follicular stimulating hormone (48.5 mIU/mL) were all within normal limits for a postmenopausal woman. Thyroid stimulating hormone levels were very low (< 0.005 uU/mL), and the patient was started on methimazole for hyperthyroidism. Additional laboratory values,such as glucose tolerance testing and insulin levels, were unavailable. The patient's workup included a transvaginal ultrasound demonstrating a uterus measuring 3.7 × 6.4 × 4.7 cm, with right ovary measuring 1.74 × 2.27 × 2.42 cm and her left ovary measuring 1.89 × 2.26 × 2.24 cm. Given the increased ovarian volume for a postmenopausal woman (normal postmenopausal average volume of

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Section: Discussionmentioning

confidence: 99%

Ovarian Stromal Hyperthecosis and Hyperandrogenemia Refractory to Hormonal Suppression

Gressel¹

2015

Obstet Gynecol Cases Rev

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Value of selective venous catheterization in the diagnosis of hyperandrogenism

Hickman

Goodman

Falcone

2017

Fertility and Sterility

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Ovarian hyperthecosis in adolescent females: two case reports and a review of the literature

Angley,

Vollenhoven,

White

2024

Journal of Pediatric Endocrinology and Metabolism

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Objectives Ovarian hyperthecosis (OHT) is a rare cause of severe hyperandrogenism in the adolescent age group. We describe two case reports, and present an approach to management in this age group based on a review of the literature. Case presentation Patient A presented at age 13 years with a 2 year history of androphonia and hirsuitism. Her testosterone level was elevated at 8.3 nmol/L, and there was marked enlargement of her ovaries bilaterally. There were no focal adrenal or ovarian lesions identified on imaging. She was treated with a gonadotropin releasing hormone (GnRH) agonist and spironolactone with biochemical and clinical improvement. Patient B presented at age 14 years with secondary amenorrhoea, and a 2 year history of androphonia, hirsutism and androgenetic alopecia. Her testosterone level was 12 nmol/L, and a pelvic ultrasound revealed numerous follicles in each ovary which were otherwise normal in size. She was managed with GnRH agonist initially, and now continues on a combined oral contraceptive pill. Conclusions Ovarian hyperthecosis needs to be considered in pre-menopausal women presenting with severe hyperandrogenism, after exclusion of androgen-producing adrenal and ovarian tumours. The principles of management in this age group are gonadotropin suppression and hormone replacement.

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Ovarian hyperthecosis and response to antiandrogens: An uncommon presentation of a common disorder

Cited by 3 publications

References 3 publications

Ovarian Stromal Hyperthecosis and Hyperandrogenemia Refractory to Hormonal Suppression

Ovarian Stromal Hyperthecosis and Hyperandrogenemia Refractory to Hormonal Suppression

Value of selective venous catheterization in the diagnosis of hyperandrogenism

Ovarian hyperthecosis in adolescent females: two case reports and a review of the literature

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