Technical difficulties of selective venous blood sampling in the differential diagnosis of female hyperandrogenism

Abstract

To determine glandular steroid release of adrenals and ovaries in female hyperandrogenism, a standardized method for percutaneous transfemoral venous blood sampling was developed. In eight volunteers and 67 patients, catheterization was performed during the early follicular phase (days 3-7; between 8 and 10 a.m.) to reduce interference from cyclic and circadian variations of secretion. Serial samplings reduced the episodic effluent changes. Anatomical variations and collateral flow as well as stress effects and the dosage of contrast media were studied. During catheterization, peripheral cortisol levels did not differ significantly from control groups. Collaterals had no effect on hormone levels. Contrast media increased cortisol effluent levels only when they were sampled following venography. Four-vessel venous sampling was found to be indicated if peripheral testosterone was more than 1.5 ng/ml and/or dehydroepiandrosterone sulfate more than 6,700 ng/ml. If an ovarian (adrenal)/peripheral gradient of testosterone exceeded 2.7 ng/ml, surgical intervention for tumor removal at the site of hormone excess was felt to be necessary.

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

“…In the present case, significantly elevated testosterone levels in the intraoperative sample collected from the right ovarian vein confirmed the site of lesion. In agreement with other authors [14], we sustain that selective venous catheterization should not be performed routinely in women presenting with symptoms and signs of severe hyperandrogenism. On the other hand, it should be reserved for women in whom uncertainty remains, especially after adrenal CT and ovarian transvaginal ultrasonography have failed to demonstrate any pathology [9,10,13].…”

“…A unilateral androgen gradient allows the localization of the lesion. Nevertheless, successful selective catheterization, even in expert hands, has been achieved in about 27% of cases [4], with the main limitation being anatomical variation in venous size and drainage [14]. In the present case, significantly elevated testosterone levels in the intraoperative sample collected from the right ovarian vein confirmed the site of lesion.…”

Falsely Elevated Serum Testosterone Levels in a Young Adult Female with Polycystic Ovarian Syndrome (PCOS) and Left Adrenal Adenoma

“…11,12 The right adrenal and right ovarian veins are particularly difficult to cannulate because of their angled origin direct from the inferior vena cava, anatomic variation and valvular obstruction, especially in nulliparous females. 11,12 Very few studies have documented basal serum testosterone levels from adrenal veins in normal premenopausal females, let alone under ACTH stimulation. One study documented basal adrenalperipheral venous testosterone gradient to be 2-6 times, with absolute adrenal vein testosterone values generally below 20 nM.…”

Fast Intraoperative Testosterone Assay Confirms the Location of an Ovarian Virilizing Tumor in a Young Girl

“…In addition to the technical complexity, the procedure carries the risks of systemic reaction to the contrast agent, hematomas, and exposure to radiation [5,15]. After localization of the source of the autonomous hormone, the next step is to perform a unilateral oophorectomy [11].…”