Use of a long-acting gonadotrophin-releasing hormone analogue in a postmenopausal woman with hyperandrogenism due to a hilus cell tumour

Abstract

Objective: The aim of this study was to prove the utility of GnRH analogues for the suppression of androgen secretion in a postmenopausal woman with a suspected virilizing ovarian tumour. Design and Methods:We present a case of a 72-year-old woman with virilization of recent onset. Hormonal studies revealed a fourfold increase in serum testosterone levels, normal dehydroepiandrosterone sulphate concentrations and high levels of serum 17-hydroxyprogesterone levels. Computed axial tomography scan of the ovaries was normal and the adrenal glands showed a discrete enlargement. The long-acting GnRH analogue, triptorelin, was injected initially (3.75 mg i.m.) and serum hormone levels were measured weekly throughout one month. Results: GnRH produced a decrease in serum testosterone levels to normal values, in parallel with the suppression of serum LH and FSH concentrations. The patient was treated for three months with triptorelin and she experienced an amelioration of the hyperandrogenic symptoms. In order to achieve a diagnosis, the patient was submitted to a laparotomy that revealed a small hilus cell tumour in the left ovary. Conclusion: GnRH analogues may offer a good therapeutic option in some states of gonadotrophindependent hyperandrogenism of ovarian origin.

Hyperandrogenism in postmenopausal woman: Is surgery reasonable for diagnosis and treatment?

“…However; unresponsiveness has been reported with some non-tumoral disorders [15]. Using gonadotropin-releasing hormone agonist (GnRH-a) against gonadotropin stimulus leading to androgen secretion as both diagnostic and therapeutic option has also been reported [16]. Such management that excludes definitive diagnosis is to be appropriate for patients who have high surgical risks.…”

Ovarian Steroid Cell Tumor Associated to Endometrial Hyperplasia and Presenting as Postmenopausal Vaginal Bleeding

“…Damage to the ovarian stroma during normal cycles can also contribute to activate the non-neoplastic counterpart of these hormone-producing cells [5]. In menopause, high levels of gonadotropin (FSH, LH) can stimulate hormone-secreting cells of the ovary to produce androgens or estrogens [7].…”

Leydig Cell Tumour in a 46,XX Child with Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

“…The hilar type tumour has predominance over the non-hilar type and is considered by definition to be a neoplasm derived from steroidogenic cells of the ovarian hilus [3,4]. The hilar type accounts for less than 0.1% of all ovarian tumours but represents 20% of steroid-producing ovarian tumours [5]. All aspects of its structure and function are identical to testicular Leydig cell tumours and the two are therefore very difficult to differentiate morphologically.…”