Virilism and Theca‐cell Hyperplasia of the Ovary: A Syndrome

Virilizing nodular ovarian stromal hyperthecosis, diabetes mellitus and insulin resistance in a postmenopausal woman. Case report

“…Ovarian stromal hyperthecosis is usually detected in women under the age of 35 years and results in virilization and menstrual irregularities which may be associated with obesity, hypertension and carbohydrate intolerance (Culiner & Shippel 1949;Bossetal. 196.5;Juddetal.…”

The Ovarian Theca Cell

“…Searle, Haines and Baker (1948) have described a virilizing ovarian tumour occurring in pregnancy which appeared to be proliferating from a boundary zone containing islands of theca cells. Culiner and Shippel (1949) in a very recent communication have presented further evidence of the existence of a concurrent relationship between ovarian thecal activity and masculinization. Steinach and Kun (1931) observed that thc assumption of masculine traits by fernalc guinea pigs, following injections of hypophyseal exiracts, was associated with thccal luteinization.…”

“…Strong evidence is accumulating to show that the actual source of androgen in the ovary is probably the theca cell. Cases of ovarian thecal activity and theca-cell turnours associated with masculinization have recently been reported (Geist and Gairies, 1942 ;Blackmun, 1942 ;Fraenkel, 1943;Stout, 1946;Twombly, 1946;Yatton and Patton, 1948;Culiner and Shippel, 1949). Iverson (1947) in her clinicopathological survey of masculinizing turnours of the ovary has suggested that the interstitial cells of arrhenoblastomata, and the polyhedral lipoid containing cells of " virilizing lipoid cell " turnours, are closely related to the paralutein or theca lutein cells of normal ovaries.…”

“…We have no explanation, however, on this basis, for the occurrence of marked virilism with these selfsame tumours (Traut and Marchetti, 1940;Blacli-mun, 1942;Stout, 1944) evcn making allowances far the slight masculinizing propensities exhibited by ocstrogen. Some (Schiller, 1933;Novak, 1947) attempt to explain this apparent paradox by maintaining that such tumours associated with yirilization are rather of adrenal than thecal origin, but even this explanation can still not account for the occurrence of these symptoms in cases exhibiting hyperthecal activity around very definite ovarian follicles where the origin of these theca cells can in no way be in doubt (Fraenkel, 1943;Culiner and Shippel, If this school's contention is correct, it must be assumed that the theca cell is not only a source of oestrogen but of androgen as well and it may even be argued that the type of hormone produced, whether androgenic or oestrogenic, will depend upon particular stresses or stimuli. This possibility cannot be denied, but it becomes very difficult, on this basis, to account for the oceiirrence of those theca cell tumours exhibiting at one and the same time symptoms of both marked masculinization and feminization.…”

Estrogenization in Women with Postmenopausal Ovarian Hyperthecosis

“…T h e term "hyperthecosis" was initially introduced by Fraenkel in 1943 to describe ovarian changes characterized by the presence of islands of luteinized cells in the stroma at a distance from follicles (11). Several years later the hyperthecosis syndrome was defined as consisting of clinical virilization in the presence of ovarian hyperthecosis (5). Further investigation indicated that indeed such ovaries can be the source of increased androgenization (1).…”