Steroid biosynthesis in the Sertoli-Leydig cell tumor: effects of insulin and luteinizing hormone

Leydig tumor in normal sized ovaries causing clitoromegaly: A case report

We describe an unusual presentation of a rare Leydig tumor presenting in bilateral ovaries that are otherwise normal in size for postmenopausal women. A 66-year-old woman presented with postmenopausal bleeding and during her work-up acutely developed clitoromegaly. Her diagnostic work-up revealed a 1.8 cm left ovarian complex cyst and extremely elevated testosterone levels. Management included hysterectomy and bilateral salpingo-oophorectomy. Final pathology revealed Leydig tumors in the bilateral ovaries. This case discusses a rare presentation of a rare tumor and highlights the importance of a thorough examination of the female genitalia and investigation for root cause.

Sertoli-Leydig cell tumors: hormonal profile after dynamic test with GnRH analogue: triptorelin represents a useful tool to evaluate tumoral hyperandrogenism

We report the case of a 15-year-old woman with signs of hyperandrogenism affected by a Sertoli-Leydig cell tumor (SLCT). In our patient, blood analysis showed a high testosterone (T) level (T: 8.53 nmol/L; nv < 1.87 nmol/L) while the GnRH-analogue test demonstrated an exaggerated secretion of 17-hydroxyprogesterone (OHP), T, and androstenedione (A) by the ovary after stimulation. We compared the GnRH-analogue test of our patient with that obtained in a group of normal and healthy women (no. 8 subjects, 16-26 years old), men (no. 4 subjects, 18-28 years old), and in a group of PCOS patients with age and body weight compared. We found in our patient a value of OHP, 17-beta estradiol (E2) and T, from 2 to 18 times higher than healthy women. When we compared our patient with healthy men, we differently observed a comparable response of T. The response of our patient was also comparable with that observed in the PCOS group for E2. During the post-surgical follow up, the GnRH-analogue test of our patient showed a response of OHP, T, and E2 comparable with that of the PCOS group. The GnRH-analogue test is a useful tool to characterize steroidogenesis in SLCT.

Obesity differentially affects serum levels of androstenedione and testosterone in polycystic ovary syndrome

OBJECTIVE

To assess androstenedione (A) and T levels in obese and nonobese patients with polycystic ovary syndrome (PCOS) after GnRH and oral glucose tolerance tests (OGTT).

DESIGN

Cross sectional study.

SETTING

Clinical research center.

PATIENT(S)

Thirty patients with PCOS, of whom 15 were obese and 15 were nonobese, and 7 women without PCOS were included in the study.

INTERVENTION(S)

The GnRH test and OGTT were performed in all subjects.

MAIN OUTCOME MEASURE(S)

Basal and stimulated levels of LH, FSH, insulin, A, and total T were measured. Areas under the curve (AUCs) and AUC change after stimulation for these hormones were calculated.

RESULT(S)

The basal T levels were significantly higher in obese than in nonobese patients with PCOS. In contrast, the basal levels of A were similar in obese and nonobese patients with PCOS. The T(AUC) after GnRH was significantly greater in obese than in nonobese patients with PCOS but was not significantly different after OGTT. The A(AUC) after GnRH and OGTT was significantly greater in nonobese than in obese patients with PCOS. However, there were no significant differences in T(AUC) and A(AUC) changes after GnRH and OGTT.

CONCLUSION(S)

A different pattern in the levels of T and A with respect to obesity in PCOS was observed, suggesting a shift in ovarian enzymatic function.

Sertoli-Leydig cell tumour in a postmenopausal woman showing all facets of the insulin resistance syndrome (IRS)

Sertoli-Leydig cell tumours are rare sex stromal tumours with an incidence of < 0.5% of all ovarian tumours. Most frequently this tumour occurs in young women with a history of amenorrhoea, hirsutism and lowered pitch. Here, we report on a woman with IRS, postmenopausal virilization and increased testosterone levels due to a Sertoli-Leydig cell tumour. This is the first case to suggest an association between IRS and Sertoli-Leydig cell tumours. Furthermore, we highlight the difficulties in detecting this ovarian tumour with sonography.

Relationship between insulin resistance and gonadotropin dissociation in obese and nonobese women with polycystic ovary syndrome

OBJECTIVE

To test the interdependence between insulin resistance (IR) and gonadotropin dissociation (GD) in polycystic ovary syndrome (PCOS).

DESIGN

Cross-sectional prospective study.

SETTING

Clinical research center.

PATIENT(S)

Thirty-two PCOS patients aged 19-34 years; 16 obese (BMI > or = 27) and 16 nonobese (BMI < 27).

INTERVENTION(S)

A 75-g oral glucose tolerance test (OGTT) and a 100-microg i.v. GnRH test were performed on different days. Blood was taken at 0, 30, 60, 90, 120, and 180 minutes in each test. Serum glucose, insulin, LH, and FSH were measured.

MAIN OUTCOME MEASURE(S)

Area under the curve was calculated for glucose, insulin, and glucose-to-insulin ratio (GIR), and for LH, FSH, and LH-FSH ratio.

RESULT(S)

Glucose, insulin, and GIR were not modified significantly during the GnRH test, nor LH, FSH and LH-FSH ratio throughout the OGTT. There were no significant differences in GIR response of patients with and without GD, nor in LH-FSH ratio of patients with and without IR, after OGTT and GnRH test. However, obese patients with IR had a significantly larger (P<.04) area under the curve for LH-FSH ratio than those without IR after GnRH test, but not after OGTT test.

CONCLUSION(S)

Insulin resistance and GD do not appear to be related events in PCOS, suggesting that each one might be determined by different genetic disorders. However, IR can affect GD after chronic stimulation in obese patients.

Sertoli-Leydig cell tumor of the ovary: a case report with endocrinologic observations

OBJECTIVE

To present a case of a Sertoli-Leydig cell ovarian tumor and discuss the endocrinologic findings.

METHODS

We describe the clinical manifestations in a female patient with an ovarian tumor and summarize the results of hormonal studies.

RESULTS

A 33-year-old woman with abrupt cessation of menses, progressive hirsutism, and weight gain because of a unilateral ovarian mass identified sonographically and an increased serum testosterone level underwent laparotomy, which disclosed a left ovarian Sertoli-Leydig cell tumor. Hysterectomy and bilateral adnexectomy were performed. Tissue extraction studies revealed 17-hydroxyprogesterone as the predominant steroid in tumor tissue in conjunction with substantially increased testosterone, free testosterone, dihydrotestosterone, androstenedione, and dehydroepiandrosterone levels and left ovarian vein effluent.

CONCLUSION

A unilateral ovarian mass associated with substantially increased serum testosterone should suggest the presence of a functioning ovarian tumor. Androgenic symptoms are a consequence of disturbed steroidogenesis from multipotential steroidogenic cells of ovarian stromal origin whose clinical effects depend on enzymatic specificity and the relative concentrations of steroids produced.

Is diabetes mellitus a risk factor for ovarian cancer? A case-control study in Utah and Washington (United States)

Insulin resistance characterizes non-insulin dependent diabetes (NIDDM). Insulin resistance may coexist in clinical syndromes with hyperestrogenism and hyperandrogenism, suggesting that the ovary may be sensitive to effects of insulin. In addition, insulin-like growth factor-I receptors, which are capable of binding insulin, have been identified in ovarian cancer tissue and are proposed to regulate cell growth. We evaluated the association between a history of diabetes mellitus and ovarian cancer in a case-control study in seven counties in Washington and in Utah (United States) during the years 1975-87. Cases included women newly diagnosed with ovarian cancer over a five-year period who were identified through population-based cancer reporting. Controls similar to cases with regard to age and county of residence were identified via household surveys or random digit dialing. The study included 595 cases and 1,587 controls. Twenty-seven cases (4.5 percent) and 72 controls (4.5 percent) reported a history of diabetes. Logistic regression analysis of the association between diabetes and ovarian cancer controlling for age, body mass index, and race resulted in an odds ratio (OR) of 0.9 (95 percent confidence interval [CI] = 0.6-1.5). The OR was not changed with further controlling for prior oral contraceptive use or prior pregnancy. None of the 20 women with nonepithelial tumors (15 of which were stromal tumors) had a history of diabetes (upper CI = 4.0). These results, together with findings of two earlier cohort studies, do not support the hypothesis that diabetes is a risk factor for epithelial ovarian cancer.