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Anantharaju A, Roy B, Deodhare KG, Srinivas BH, Bade BA, Naik P. Paraneoplastic Erythropoiesis in Patients With Ovarian Sertoli Leydig Cell Tumors: Retrospective Study From Tertiary Care Institute. Indian J Surg Oncol 2023; 14:497-503. [PMID: 37324306 PMCID: PMC10267067 DOI: 10.1007/s13193-022-01585-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022] Open
Abstract
To study the clinical, paraneoplastic hematological presentation of Sertoli Leydig cell tumor patients. This retrospective study involved women with Sertoli Leydig cell tumors treated at JIPMER from 2018 to 2021. We reviewed the hospital registry for the Sertoli Leydig cell tumor among all the ovarian tumors being treated in the department of obstetrics and gynecology. We retrieved the datasheets of patients with Sertoli Leydig cell tumor and studied their clinical and hematological presentation, their management, complications, and follow-up. We had 5 patients of Sertoli Leydig cell tumor of 390 ovarian tumors operated during the study period. The mean age at presentation was 31.6 years. All 5 patients had hirsutism and menstrual irregularity. One patient presented with symptoms of polycythemia along with these complaints. Elevated serum testosterone was seen in all (mean being 688 ng/ml). Mean preoperative hemoglobin was 15.84%, and mean hematocrit was 50.14%. Fertility-sparing surgery was performed in 3 of them and the rest had complete surgery. All patients were in Stage IA. Histologically, one had Pure Leydig cell, three had steroid cell tumor not otherwise specified and one was mixed Sertoli Leydig cell tumor. After the operation, the hematocrit and testosterone levels came down to the normal range. The virilizing manifestations regressed over 4-6 months. With a follow-up period ranging from 1 to 4 years, all 5 patients are alive, one patient had a disease recurrence in the ovary after 1 year of primary surgery. She is disease-free following the second surgery. The rest of the patients had no disease recurrence and are disease-free following surgery. Virilizing ovarian tumors can have paraneoplastic polycythemia which needs to be looked into while evaluating these patients. Similarly, while evaluating polycythemia in young females, an androgen-secreting tumor has to be ruled out as it is reversible and completely treatable.
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Affiliation(s)
| | - Baishali Roy
- Department of Gynecology, JIPMER, Pondicherry, India
| | | | | | | | - Parvathi Naik
- Department of Gynecology, JIPMER, Pondicherry, India
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Higuchi A, Tsuji S, Amano T, Kasahara K, Kimura F, Murakami T. Ovarian Leydig cell tumour diagnosis in a postmenopausal woman with uterine bleeding: a case report and literature review. J OBSTET GYNAECOL 2022; 42:2519-2521. [PMID: 35164632 DOI: 10.1080/01443615.2022.2027897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Asuka Higuchi
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Tsukuru Amano
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Kyoko Kasahara
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Fuminori Kimura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
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Demir AY, Blok BB, Brinkhuis EA, Oldenburg-Ligtenberg CP. Hyperandrogenism due to ovarian Leydig cell tumour presenting with polycythaemia. BMJ Case Rep 2022; 15:e249651. [PMID: 35840164 PMCID: PMC9295641 DOI: 10.1136/bcr-2022-249651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/03/2022] Open
Abstract
A postmenopausal woman in her 60s was referred due to an elevated haemoglobin value found during her annual check-up. On physical examination, characteristic features of hyperandrogenism were observed which were not earlier mentioned. Laboratory investigations revealed polycythaemia accompanied by a normal erythropoietin and a negative analysis for JAK2-V617F mutation. A disproportionally and markedly elevated testosterone in combination with normal levels of adrenal androgens raised the suspicion of an ovarian source. CT scan showed nodular hyperdense lesions in both ovaries. A bilateral oophorectomy was performed and histological evaluation unfolded a Leydig cell ovarian tumour. Testosterone levels and haematological parameters normalised after surgery. Polycythaemia secondary to hyperandrogenism in postmenopausal women is an extremely rare condition and patients should be carefully analysed for the presence of androgen-secreting neoplasms. Diagnosis of the underlying pathology requires careful history, physical examination and comprehensive investigation. Treatment for this condition is surgery and resolves polycythaemia.
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Affiliation(s)
- Ayşe Y Demir
- Department of Clinical Chemistry and Haematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Bas B Blok
- Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands
| | - Egbert A Brinkhuis
- Department of Gynaecology and Obstetrics, Meander Medical Centre, Amersfoort, The Netherlands
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Shwana S, Shrikrishnapalasuriyar N, Yin W, Vij M, Kalhan A. An Occult Leydig Cell Tumour in a Postmenopausal Woman Presenting with Alopecia and Hirsutism: A Case Report. TOUCHREVIEWS IN ENDOCRINOLOGY 2022; 17:75-78. [PMID: 35118450 DOI: 10.17925/ee.2021.17.1.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 01/15/2023]
Abstract
Progressive hirsutism and moderate to severe male-pattern balding in women requires exclusion of an adrenal or ovarian tumour, especially in the presence of significantly elevated androgen levels. We present the case of a 68-year-old woman who was referred to an endocrinology clinic with insidious onset excessive facial hair growth and loss of scalp hair. Her testosterone levels were significantly elevated at 13 nmol/L (normal range: 0.1-1.4 nmol/L), although dehydroepiandrosterone sulphate and 17-hydroxyprogesterone levels were normal, suggestive of an ovarian source of androgens. Repeated radiologic investigations, including pelvic ultrasound, and abdominal and pelvic computed tomography, could not identify the obvious source of androgens. Based on strong clinical suspicion of an ovarian tumour, she underwent an elective salpingo-oophorectomy, which detected an occult Leydig cell tumour on histopathological analysis. Post-operatively, her hyperandrogenic features significantly improved and testosterone levels normalized.
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Affiliation(s)
| | | | - Win Yin
- Royal Glamorgan Hospital, Llantrisant, Wales, UK
| | | | - Atul Kalhan
- Royal Glamorgan Hospital, Llantrisant, Wales, UK
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Ferrinho C, Silva E, Oliveira M, Sequeira Duarte J. Ovarian Leydig cell tumor and postmenopausal hirsutism with signs of virilisation. BMJ Case Rep 2021; 14:14/3/e240937. [PMID: 33731391 PMCID: PMC7978078 DOI: 10.1136/bcr-2020-240937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 71-year-old woman was referred to the endocrinology clinic to investigate postmenopausal hirsutism with 10 years of evolution. She had history of regular menses and menopause with 50 years old. Physical examination showed a male pattern facies, deepening of the voice, androgenic alopecia and hirsutism with a score of 23 according to the modified Ferriman-Gallwey scale. Testosterone and androstenedione were increased. Transvaginal ultrasound, abdominal and pelvic CT showed uterine fibroids with no pathological findings in the adrenals or ovaries. Since she had postmenopausal vaginal bleeding, uterine fibroids and suspicion of an ovarian source for her hyperandrogenism, total hysterectomy and bilateral oophorectomy were performed. Histopathological diagnosis was a Leydig cell tumour located in left ovary and endometrial carcinoma. Improvement of hirsutism was started to notice 1 month after the surgery and she was referred to the oncology clinic for adjuvant treatment.
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Affiliation(s)
- Cátia Ferrinho
- Endocrinology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Eugénia Silva
- Endocrinology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Manuela Oliveira
- Endocrinology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - João Sequeira Duarte
- Endocrinology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
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Shwana S, Shrikrishnapalasuriyar N, Yin W, Vij M, Kalhan A. An Occult Leydig Cell Tumour in a Postmenopausal Woman Presenting with Alopecia and Hirsutism: A Case Report. EUROPEAN ENDOCRINOLOGY 2021. [DOI: 10.17925/ee.2021.1.1.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Shakir MK, Snitchler AN, Vietor NO, Mai VQ, Hoang TD. Bilateral Ovarian Leydig Cell Tumors in a Postmenopausal Woman Causing Hirsutism and Virilization. AACE Clin Case Rep 2020; 7:26-28. [PMID: 33851015 PMCID: PMC7924158 DOI: 10.1016/j.aace.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective To evaluate a rare case of a postmenopausal woman with hirsutism and virilization due to Leydig cell tumors (LCTs) of both ovaries. Methods In this challenging case, the diagnostic studies included the detection of total/free testosterone, hemoglobin, and estradiol levels; adrenal computed tomography; and pelvic magnetic resonance imaging. Results A 61-year-old woman presented for the evaluation of hirsutism. Physical examination revealed normal vital signs and evidence of virilization. The baseline laboratory findings were hemoglobin level of 16.2 g/dL (reference, 12.0-15.5 g/dL), total testosterone level of 803 ng/dL (reference, 3-41 ng/dL), and free testosterone level of 20.2 pg/mL (reference, 0.0-4.2 pg/mL). Pelvic magnetic resonance imaging showed bilateral homogeneous ovarian enhancement. Based on the magnetic resonance imaging findings and clinical presentation, the patient was diagnosed with ovarian hyperthecosis and underwent laparoscopic bilateral oophorectomy. Pathology confirmed LCTs in both ovaries. Six months later, testosterone levels normalized, with significant improvement in hirsutism and virilization. Conclusion Clinicians should be aware of androgen-secreting tumors, including rare bilateral LCTs in postmenopausal women presenting with progressing hirsutism and virilization. Marked hyperandrogenemia with total testosterone level of >150 ng/dL (5.2 nmol/L) or serum dehydroepiandrosterone sulfate level of >700 μg/dL (21.7 mmol/L) is typically found. It should be recognized that diffuse stromal Leydig cell hyperplasia and small LCTs may be missed on imaging, and in some cases only pathology can confirm the result.
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Affiliation(s)
- Mohamed K.M. Shakir
- Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Andrea N. Snitchler
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nicole O. Vietor
- Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Vinh Q. Mai
- Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Thanh D. Hoang
- Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
- Address correspondence and reprint requests to Dr. Thanh D. Hoang, Division of Endocrinology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
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LeVee A, Suppogu N, Walsh C, Sacks W, Simon J, Shufelt C. The Masquerading, Masculinizing Tumor: A Case Report and Review of the Literature. J Womens Health (Larchmt) 2020; 30:1047-1051. [PMID: 32991246 DOI: 10.1089/jwh.2020.8548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Androgen-producing tumors in women are rare neoplasms that can cause secondary virilizing characteristics. Of patients presenting with symptoms of hyperandrogenism, these tumors are found in ∼0.2% of cases. Androgen-producing tumors can arise from the ovary or the adrenal gland. Those arising from the ovary are rare, accounting for <5% of all ovarian tumors. This case presents a hilar Leydig cell tumor of the ovary, which resulted in secondary virilization of a 45-year-old female 2 months after cessation of combined oral contraceptives (COC). Laboratory findings showed markedly elevated total and free testosterone concentrations with normal dehydroepiandrosterone sulfate, however neither pelvic ultrasound nor magnetic resonance imaging demonstrated any masses. Venous sampling under fluoroscopy revealed supraphysiologic testosterone concentrations from the right ovarian vein suggesting the source. The patient underwent bilateral salpingo-oophorectomy revealing a 1.3 cm hilar cell tumor of the right ovary. This article reviews the clinical features, diagnosis, and treatment of hilar Leydig cell tumors and describes the long-term complications of supraphysiologic testosterone levels. As the tumor presented after cessation of COC, we also review the mechanisms by which COC might suppress supraphysiologic androgen levels and mask the secondary virilizing effects of androgen-producing tumors.
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Affiliation(s)
- Alexis LeVee
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nissi Suppogu
- Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Christine Walsh
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wendy Sacks
- Department of Endocrinology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - James Simon
- IntimMedicine Specialists, Department of Obstetrics and Gynecology, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
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9
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An Excessive Testosterone Producing Testicular Leydig Cell Tumor as a Rare Cause of Secondary Acquired Erythrocytosis. Urology 2020; 142:e32-e35. [DOI: 10.1016/j.urology.2020.03.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 01/07/2023]
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10
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Steroid Cell Tumour of Ovary in a Post-hysterectomy Woman: A Rare Case Report and Review of Literature. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-019-0337-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Ovarian sex cord-stromal tumors are uncommon tumors and clinically differ from epithelial tumors. They occur across a wide age range and patients often present with hormone-related symptoms. Most are associated with an indolent clinical course. Sex cord-stromal tumors are classified into 3 main categories: pure stromal tumors, pure sex cord tumors, and mixed sex cord-stromal tumors. The rarity, overlapping histomorphology and immunoprofile of various sex cord-stromal tumors often contributes to diagnostic difficulties. This article describes the various types of ovarian sex cord-stromal tumors and includes practical approaches to differential diagnoses and updates in classification.
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Affiliation(s)
- Krisztina Z Hanley
- Department of Pathology, Emory University Hospital, Rm H-187, 1364 Clifton Road, Northeast, Atlanta, GA 30322, USA.
| | - Marina B Mosunjac
- Department of Pathology, Grady Memorial Hospital, 80 Jesse Hill Jr Dr SE, Atlanta, GA 38303, USA
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Cannavò L, Zirilli G, Lima M, Iaria G, De Luca F, Valenzise M. Erythrocytosis as the first manifestation of adrenal carcinoma. Pediatr Blood Cancer 2019; 66:e27685. [PMID: 30859743 DOI: 10.1002/pbc.27685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Laura Cannavò
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Childhood Human Pathology, University of Messina, Messina, Italy
| | - Giuseppina Zirilli
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Childhood Human Pathology, University of Messina, Messina, Italy
| | - Mario Lima
- Sant'Orsola Hospital, Department of Pediatric Surgery, University of Bologna, Bologna, Italy
| | - Graziella Iaria
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Filippo De Luca
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Childhood Human Pathology, University of Messina, Messina, Italy
| | - Mariella Valenzise
- G. Martino Hospital, Pediatric Unit, Department of Adulthood and Childhood Human Pathology, University of Messina, Messina, Italy
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Moura FS, Costa-Barbosa FA, Leao SC, Nicolau SM, Kater CE, Monteagudo PT. Confounder factors masking a Leydig-cell ovarian tumor in a post-menopausal woman treated for androgen-positive receptor breast cancer. Gynecol Endocrinol 2017; 33:675-679. [PMID: 28443693 DOI: 10.1080/09513590.2017.1318373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Post-menopause hyperandrogenism is a condition that needs careful evaluation. Aromatase inhibitors (AI), which are important in the management of positive estrogen breast cancer, and chronic kidney disease (CKD) can puzzle the evaluation of this condition. A postmenopause female with type-2 diabetes and advanced CKD was attended due to progressive virilization, which has started after the introduction of an AI for breast cancer 5 years earlier. Clinical and radiological investigation has confirmed a pure Leydig cell tumor as source of hyperandrogenism. Re-evaluation of the breast tumor immunohistochemistry has shown positive androgen receptor expression and negative expression for estrogen, progesterone and HER-2 receptors. Even though an ovarian tumor was the source of androgen excess, we discuss that AI could exert a slight contribution to patient's virilization by reducing estradiol counterbalance. Also, although the onset of hyperandrogenic symptoms was unclear, we could not exclude that the ovarian tumor had produced enough androgens to play a role in breast tumor progression. This case report supports the literature regarding the possible association between Leydig cell tumor and androgen-receptor-positive breast cancer development. Finally, progressive hyperandrogenic symptoms in postmenopause, even under AI therapy or the presence of advanced CKD, impose a more detailed investigation.
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Affiliation(s)
| | | | | | - Sergio Mancini Nicolau
- c Gynecology Division Department of Medicine, Universidade Federal de São Paulo , São Paulo , Brazil
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Gheorghisan-Galateanu AA, Terzea D, Valea A, Carsote M. MENOPAUSAL ANDROGEN EXCESS - ASSOCIATED CARDIO-METABOLIC RISK: CLUES FOR OVARIAN LEYDIG CELL TUMOUR (CASE REPORT AND MINI-REVIEW OF LITERATURE). ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:356-363. [PMID: 31149200 DOI: 10.4183/aeb.2017.356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Ovarian Leydig cell tumour is a very rare steroid hormones producing mass, causing clinical and biochemical hyperandrogenism. Even if the level of evidence is based on case studies, many authors (but not all) agree that raised androgens increase the cardio-metabolic risk thus early diagnosis and treatment are necessary On the other hand, the endocrine features pointing an ovarian tumour source of testosterone do not indicate the specific histological finding which needs a post-operative conformation. Case presentation We report a case of a 60-year-old woman with a 4-year history of progressive virilisation in association with hypertension, high number of red blood cells, impaired glucose tolerance and dyslipidemia. Total testosterone was 20 times above normal with suppressed gonadotropins, inadequate for menopause. Trans-vaginal ultrasound and pelvic and abdominal computerized axial tomography imaging revealed a right ovarian solid nodule, and no evidence of alteration in the adrenal glands. Total hysterectomy and bilateral salpingo-oophorectomy were performed. Histopathology and immunohistochemistry confirmed the diagnosis of Leydig cell tumour. After surgery, androgen levels returned to normal and the doses of anti-hypertensive drugs were reduced. Conclusions The hyperandrogenic state with elevated plasma testosterone and progressive signs of virilization raises suspicion of an ovarian androgen-secreting tumor. For a postmenopausal patient with hyperandrogenism the diagnosis of Leydig cell tumour should be considered. However, the exact diagnosis is provided by post-operative histological exam. Prolonged exposure to hyperandrogenism may generate cardiovascular abnormalities and metabolic syndrome which after tumor excision and removal of the source of androgen hormones are expected to significantly improve.
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Affiliation(s)
- A A Gheorghisan-Galateanu
- "Carol Davila" University of Medicine and Pharmacy, Department of Cellular and Molecular Biology and Histology, Bucharest, Romania.,"C.I.Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - D Terzea
- "C.I.Parhon" National Institute of Endocrinology, Bucharest, Romania.,Monza Hospital - Onco Team, Diagnostic, Bucharest, Romania
| | - A Valea
- University of Medicine and Pharmacy Cluj-Napoca, Department of Endocrinology, Cluj-Napoca, Romania
| | - M Carsote
- "C.I.Parhon" National Institute of Endocrinology, Bucharest, Romania
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Dolinko AV, Ginsburg ES. Hyperandrogenism in menopause: a case report and literature review. FERTILITY RESEARCH AND PRACTICE 2015; 1:7. [PMID: 28620512 PMCID: PMC5424333 DOI: 10.1186/2054-7099-1-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/18/2015] [Indexed: 12/17/2022]
Abstract
Hyperandrogenism is an uncommon diagnosis in postmenopausal women. In this case, we report on a 69-year-old postmenopausal woman who presented with several months of worsening hirsutism of the face, neck, and chin, which was confirmed on examination. Laboratory testing revealed markedly elevated testosterone levels and typical post-menopausal gonadotropin levels. Transvaginal ultrasonography and pelvic and abdominal magnetic resonance imaging (MRI) failed to reveal an ovarian or adrenal abnormality. The patient was a poor surgical candidate and was counseled to start on gonadotropin releasing hormone (GnRH) agonist therapy. Administration of leuprolide resulted in a dramatic decline in testosterone levels. The patient reported significant “hot flashes”, difficulty sleeping, anxiety, and depression secondary to treatment, and patient discontinued leuprolide therapy 3 months after initiation. To our knowledge, this is the first case that describes a woman being treated with a GnRH agonist for hyperandrogenism subsequently discontinuing GnRH agonist treatment due to significant side-effects. This case also highlights the difficulty of prescribing appropriate but off-label use of expensive medications not covered by insurance in a senior population of limited income.
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Affiliation(s)
- Andrey V Dolinko
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA USA
| | - Elizabeth S Ginsburg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA USA
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16
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Glintborg D, Altinok ML, Petersen KR, Ravn P. Total testosterone levels are often more than three times elevated in patients with androgen-secreting tumours. BMJ Case Rep 2015; 2015:bcr-2014-204797. [PMID: 25616651 DOI: 10.1136/bcr-2014-204797] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Hirsutism is present in up to 25% reproductive aged women and is most often caused by polycystic ovary syndrome. Less than 5% of patients with hirsutism are diagnosed with rare endocrine diseases including ovarian or adrenal androgen-producing tumours, but these tumours may be malignant and need surgery. Terminal hair growth on lip and chin gradually increases after menopause, which complicates distinction from normal physiological variation. Precise testosterone assays have just recently become available in the daily clinic. We present three women diagnosed with testosterone-producing tumours. Gold standard techniques were used to measure testosterone levels. All tumours originated from the ovaries. Based on the present cases and the existing literature, we suggest that androgen-producing tumours should be suspected in patients with rapid progression of hyperandrogen symptoms, particularly when total testosterone levels are above three times the upper reference limit.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense C, Denmark
| | - Magda L Altinok
- Department of Endocrinology, Odense University Hospital, Odense C, Denmark
| | - Kresten R Petersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense C, Denmark
| | - Pernille Ravn
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense C, Denmark
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17
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Saraceno G, Barresi V, Trimarchi F, Cannavo S. Occult leydig cell tumour and androgen-receptor positive breast cancer in a woman with severe hyperandrogenism. J Ovarian Res 2013; 6:43. [PMID: 23816265 PMCID: PMC3703298 DOI: 10.1186/1757-2215-6-43] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/19/2013] [Indexed: 11/18/2022] Open
Abstract
Leydig cell tumours represent more than 75% of all testosterone-secreting ovarian masses. These benign tumours are frequently occult or very small, but cause dramatic virilization. Chronic hyperandrogenism can also induce systemic complications, which increase morbidity and mortality risk. One of the most obvious effects of increased testosterone levels is polycythemia, a complication which induces dermatologic, osteoarticular and gastrointestinal manifestations and is associated with increased thrombotic risk. However, scientific literature reports few data concerning etiopathogenesis and management of polycythemia in patients with Leydig cell tumours. Moreover, no data are available about the effect of androgen excess on other concomitant tumours expressing androgen receptors. In this paper we report for the first time the case of a woman, with previous infertility, dramatic virilisation and chronic erythrocytosis, who was affected by an occult Leydig cell tumour and an androgen receptor positive breast cancer. This association gives us the opportunity to discuss the role of the steroid receptor expression of breast cancer in the presence of circulating androgen excess. Moreover, we demonstrate for the first time that treatment with flutamide (anti-androgen drug) is able to normalize blood cell count and haematocrit, before of achieving the definitive cure of hyperandrogenism by oophorectomy.
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Affiliation(s)
- Giovanna Saraceno
- Department of Clinical and Experimental Medicine, Via Consolare Valeria, Messina, 98125, Italy.
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Abstract
Evidence of clinical and/or biochemical androgen excess connotes a unique differential diagnosis in postmenopausal women. Providers need to be able to discriminate between changes of the normal ageing process compared to potential pathology in older women. The evaluation and treatment of postmenopausal hirsutism and hyperandrogenism is reviewed. Androgen excess may have long-term negative health consequences and as such should be detected and treated.
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Affiliation(s)
- Micol S Rothman
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO and VA Research Service, Denver, CO, USA
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