1
|
Szeliga A, Zysnarska A, Podfigurna A, Maciejewska-Jeske M, Moszyński R, Sajdak S, Jasiński P, Frankowski A, Genazzani AR, Męczekalski B. Ovarian steroid cell tumor as an example of severe hyperandrogenism in 45-year-old woman. Gynecol Endocrinol 2020; 36:303-307. [PMID: 31718336 DOI: 10.1080/09513590.2019.1689551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Approximately, 5% of ovarian tumors have hormonal activity. Steroid cell tumors (SCTs) represent about 0.1% of all ovarian tumors. They cause hyperandrogenism associated with typical virilization. In this case report, we present 45-year-old women with unmalignant ovarian SCT-producing androgens which cause severe virilization and secondary amenorrhea lasting two years. Transvaginal ultrasound, computed tomography of adrenal glands, magnetic resonance imaging of small pelvis, laboratory tests (including serum concentration of FSH, LH, testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEA-S), as well as ROMA index) were performed. During hormonal evaluation, elevated concentrations of serum T - on admission 1.72 ng/ml and one month later 3.75 ng/ml (normal range 0.08-0.82 ng/ml) and A - 24.90 ng/ml (normal range 0.40-3.40 ng/ml) were found. The ROMA index was within the normal range. Enlargement of the left ovary by solid mass 56 × 43 mm was found during ultrasound examination. Based on small pelvis MRI scan and hormonal finding, patient was qualified for laparotomy. During this procedure, the left salpingo-oophorectomy with removal of the tumor was performed. The histopathological examination identified SCT. During follow-up examination, one day after surgery, we found serum testosterone levels within normal ranges - 0.74 ng/ml (normal range 0.08-0.82 ng/ml). This case shows that hormone-producing ovarian tumors are rare but very important clinical causes of severe hyperandrogenism.
Collapse
Affiliation(s)
- Anna Szeliga
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Aleksandra Zysnarska
- Students Scientific Society of the Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Podfigurna
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Rafał Moszyński
- Division of Gynecological Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Stefan Sajdak
- Division of Gynecological Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Jasiński
- Department of Pathology, Gynecological and Obstetric Clinical Hospital in Poznan, Poznan, Poland
| | - Andrzej Frankowski
- Department of Pathology, Gynecological and Obstetric Clinical Hospital in Poznan, Poznan, Poland
| | - Andrea R Genazzani
- Department of Reproductive Medicine and Child Development, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Błażej Męczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
2
|
Shu S, Deng S, Tian JQ, Chen R, Sun JA, Yu Q, Zhu Liu F, Huang LR, Pan YL, Yang XJ, Fan BQ, Liu YH. The clinical features and reproductive prognosis of ovarian neoplasms with hyperandrogenemia: a retrospective analysis of 33 cases. Gynecol Endocrinol 2019; 35:825-828. [PMID: 30990090 DOI: 10.1080/09513590.2019.1599855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The aim of this study is to review the natural course, clinical features, and reproductive prognosis of ovarian tumors associated with hyperandrogenemia. We retrospect 33 patients of ovarian tumors with hyperandrogenemia. Thirty cases (91%) were sex cord-stromal tumors. Sertoli-Leydig cell tumors, Leydig cell tumors, and steroid cell tumors were the most common types. It is not possible, to predict the pathological subtypes based on androgen levels alone. Most of these tumors were solid masses, with an average diameter of 3.9 cm. These tumors are soft or fragile, no clear boundary with normal tissue, thus excision is superior to exfoliation. The average disease course of the top three tumors was 32.6, 35.4, and 67.7 months, respectively. Among 11 married women with a desire to get pregnant, nine cases resumed menstrual periods after surgery and became pregnant naturally. Hyperandrogenemia might predict a better prognosis. The asynchronism of hyperandrogenemia and undetectable tumor may cause irreversible change and emotional depress, the methods of early diagnosis need further study.
Collapse
Affiliation(s)
- Shan Shu
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| | - Shan Deng
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| | - Jie Qin Tian
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| | - Rong Chen
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| | - Jun Ai Sun
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| | - Qi Yu
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| | - Feng Zhu Liu
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| | - Li Rong Huang
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| | - Ya Ling Pan
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| | - Xin Jia Yang
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| | - Bo Qing Fan
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| | - Yuan Hai Liu
- a Peking Union Medical College Hospital , Dongcheng-qu , China
| |
Collapse
|
3
|
Zhang Y, Luo S, Gong Z, Feng X, Wang Z, Zhu H, Wang Y. Improvement of hyperandrogenism, oligo-ovulation, and ovarian morphology in a patient with polycystic ovary syndrome: possible role of ovarian wedge resection. Gynecol Endocrinol 2018; 34:460-463. [PMID: 29298536 DOI: 10.1080/09513590.2017.1395840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is an endocrinological abnormality which typically presents as hormones disorder and/or infertility. It has received more and more attention in recent years though its pathogenesis is still unclear. Ovarian mucinous adenoma is a rarely pathological type which generates from epithelial cell of ovary. Here we present a patient with PCOS and ovarian mucinous tumor (occasionally discovered by cesarean section) receiving a complete relief after benign ovarian tumor excision. In this case, tumor excision played as a partial resection of ovary which might result in the normalized concentration level of hormones and morphology of ovary. This report suggests that therapeutic strategies for PCOS should be considered more carefully and individually.
Collapse
Affiliation(s)
- YuanYuan Zhang
- a Department of Gynecology and Obstetrics , Henan Provincial People's Hospital , Zhengzhou , PR China
- b Department of Gynecology Cancer , Cancer Hospital Chinese Academy of Medical Sciences , Beijing , PR China
| | - SuiYu Luo
- a Department of Gynecology and Obstetrics , Henan Provincial People's Hospital , Zhengzhou , PR China
| | - ZhiQuan Gong
- c Department of Pathology , Henan Provincial People's Hospital , Zhengzhou , PR China
| | - XiaoYa Feng
- d Department of Foreign Languages , Pingdingshan University , Pingdingshan , PR China
| | - ZiYi Wang
- e Department of Gynecology Cancer , Hunan Cancer Hospital , Changsha , PR China
| | - HaoHui Zhu
- f Department of Ultrasound , Henan Provincial People's Hospital , Zhengzhou , PR China
| | - Yu Wang
- a Department of Gynecology and Obstetrics , Henan Provincial People's Hospital , Zhengzhou , PR China
| |
Collapse
|
4
|
Lambrinoudaki I, Dafnios N, Kondi-Pafiti A, Triantafyllou N, Karopoulou E, Papageorgiou A, Augoulea A, Armeni E, Creatsa M, Vlahos N. A case of postmenopausal androgen excess. Gynecol Endocrinol 2015; 31:760-4. [PMID: 26287476 DOI: 10.3109/09513590.2015.1075500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ovarian steroid cell tumors are very rare but potentially life-threatening neoplasms. They represent less than 0.1% of all ovarian tumors, typically present in premenopausal women and frequently manifest with virilization. Signs of hyperandrogenism may appear in postmenopausal women due to tumorοus and non-tumorοus adrenal and ovarian causes as well due to the normal aging process. In any case, steroid cell tumor should be suspected in postmenopausal women who present with rapid progressive androgen excess symptoms. This report describes a case of a 67-year-old postmenopausal woman with signs of hyperandrogenism, where an ovarian steroid cell tumor was diagnosed and treated by laparoscopic bilateral salpingo-oophorectomy and synchronous hysterectomy.
Collapse
Affiliation(s)
| | - Nikos Dafnios
- b 2nd Department of Surgery , National and Kapodistrian University of Athens, Aretaieio Hospital , Athens , Greece , and
| | | | - Nikos Triantafyllou
- c First Neurology Department , National and Kapodistrian University of Athens, Aiginiteion Hospital , Athens , Greece
| | | | | | | | - Eleni Armeni
- a 2nd Department of Obstetrics and Gynecology and
| | | | | |
Collapse
|
5
|
Mrozińska S, Kiałka M, Doroszewska K, Milewicz T, Jach R. [The ovarian origin of hiperandrogenism in the postmenopausal woman the adrenal adenoma--a case report]. Przegl Lek 2015; 72:387-390. [PMID: 26817354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hyperandrogenism is a clinical condition characterized by excessive secretion of male sex hormones. An excess amount of androgens in women is manifested by symptoms of defeminization and masculinization. Hormonally active adrenal and ovarian tumors and non-tumor causes must be considered in the differential diagnosis. The authors describe the case of a 77-year-old patient who had hirsutism and reduction of the timbre of the voice. At the beginning she was suspected to have adrenal hyperandrogenism because of the tumor in the adrenal gland. Then adrenalectomy was conducted but it did not lead to alleviate symptoms. A MRI of the pelvis revealed a change of appendages projection and the patient underwent the total hysterectomy. The normalization of testosterone levels as well as reduction of the symptoms was observed after the operation. Finally, the ovary etiology of hyperandrogenism was confirmed. This case report is an example of difficulties in recognition the etiology of hyperandrogenism.
Collapse
|
6
|
Paragliola RM, Torino F, Senes P, Castellino L, Salutari V, Pontecorvi A, Scambia G, Corsello SM. "Occult" ovarian Leydig cell tumor: when laboratory tells more than imaging. Endocrine 2014; 46:351-4. [PMID: 24091542 DOI: 10.1007/s12020-013-0066-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
Abstract
Hyperandrogenism is a common finding in premenopausal age and is generally caused by polycystic ovarian syndrome or other benign disease. Androgen-secreting tumors represent only 0.2 % of the causes of hyperandrogenism and usually present with severe clinical features, abrupt onset, and very high androgens levels. We describe here three cases of occult ovarian Leydig cell tumors suspected on the basis of severe clinical features of hyperandrogenism rapidly worsening, with elevated serum total testosterone levels, in which bilateral ovariectomy was performed and tumor was confirmed by post-operative histology. In all three cases, imaging was negative for ovarian tumor. Moreover, in one case the confounding concomitant finding of bilateral adrenal masses posed an additional challenge. Our experience highlights that testosterone levels represent the most helpful marker in the diagnosis of androgen-secreting ovarian tumor. In the absence of imaging findings, bilateral ovariectomy should be indicated, if supported by unequivocal clinical and laboratory data.
Collapse
Affiliation(s)
- Rosa Maria Paragliola
- Endocrinology Unit, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Pelusi C, Forlani G, Zanotti L, Gambineri A, Pasquali R. No metabolic impact of surgical normalization of hyperandrogenism in postmenopausal women with ovarian androgen-secreting tumours. Clin Endocrinol (Oxf) 2013; 78:533-8. [PMID: 22583337 DOI: 10.1111/j.1365-2265.2012.04438.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 03/01/2012] [Accepted: 05/08/2012] [Indexed: 11/28/2022]
Abstract
AIM To examine the impact of surgical normalization of testosterone on body weight and on glucose and lipid metabolism and insulin sensitivity in a group of hyperandrogenic women with ovarian androgen-secreting tumours (OAST). METHODS Five consecutive postmenopausal hyperandrogenic patients (aged 63 ± 5 years) with a diagnosis of OAST were prospectively evaluated. Clinical signs, symptoms and metabolic and hormonal parameters were collected at the time of the diagnosis and at follow-up, 12 months after surgical oophorectomy. A group of 15 age-matched and body mass index-matched postmenopausal control women served as a reference group. RESULTS At baseline, patients with OAST had very high testosterone levels and inappropriately low gonadotrophin levels for their menopausal status. All the women were overweight or obese, and one had a history of polycystic ovary syndrome and Type 2 diabetes. Twelve months after surgical oophorectomy, testosterone and gonadotrophin levels returned to appropriate values for menopausal status in all patients; however, no change in body weight was found. Fasting glucose levels slightly increased (P < 0·05) without any significant change in other metabolic parameters. In the woman with diabetes, a moderate decrease in haemoglobin A1c occurred. Red blood cell count and haematocrit values were normalized (P < 0·05, respectively). CONCLUSION Normalization of androgen levels achieved after surgical oophorectomy did not cause any significant change in body weight and insulin sensitivity. These findings may offer a different perspective on the impact of hyperandrogenaemia on metabolism.
Collapse
Affiliation(s)
- Carla Pelusi
- Division of Endocrinology, S. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Bologna, Italy
| | | | | | | | | |
Collapse
|
8
|
Abstract
The effectiveness of laparoscopic ovarian drilling for treatment of anovulation in polycystic ovarian syndrome (PCOS) has been proved. The role of ovarian surgery in the treatment of symptoms related to hyperandrogenaemia, such as hirsutism and acne, has been less clear. This review sought to evaluate the effectiveness of ovarian surgery in the treatment of non-infertility symptoms related to PCOS. A systematic literature review was undertaken, by searching the Medline database for the years 1966-2002 inclusive. The search yielded 19 studies recording the outcomes of hirsutism, acne or androgen levels from surgical treatment for women with PCOS: three assessed unilateral oophorectomy; two ovarian wedge resection; and 14 ovarian drilling. There was no consensus of a clear improvement in hirsutism or acne in women undergoing surgery. There was a trend towards a decrease in serum androgen levels in most studies. We conclude that, while there is evidence that ovarian surgery may decrease androgen levels in some women with PCOS, the evidence that this translates into a clear improvement in hirsutism and acne is less clear. Further high quality clinical research, including data from randomisation, would be required to answer this question.
Collapse
Affiliation(s)
- N P Johnson
- University Division of Obstetrics and Gynaecology, National Women's Hospital, Auckland, New Zealand.
| | | |
Collapse
|
9
|
Astwood D, Yoon HS, Manning PJ. Hyperandrogenism in a patient with previous colorectal cancer. Intern Med J 2006; 36:751-2. [PMID: 17040367 DOI: 10.1111/j.1445-5994.2006.01175.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
Escarda Gelabert A, Bonet Vidal L, Vaquer Arnau P, Vanrell Garau M, Company Campins M, Codina Marcet M, Obrador Adrover A. Esteatohepatitis no alcohólica asociada a hiperplasia estromal ovárica. Gastroenterología y Hepatología 2005; 28:375-7. [PMID: 16137470 DOI: 10.1157/13077757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Alterations in liver function tests have previously been reported in patients with ovarian disease. We report the case of a woman with prolonged hypertransaminasemia, significant hirsutism and android phenotype who was diagnosed with nonalcoholic steatohepatitis and ovarian stromal hyperplasia.
Collapse
Affiliation(s)
- A Escarda Gelabert
- Servicio de Aparato Digestivo, Hospital Universitario Son Dureta, Palma de Mallorca, Baleares, España.
| | | | | | | | | | | | | |
Collapse
|
11
|
Volpi E, Lieberman SA, Ferrer DM, Gilkison CR, Rasmussen BB, Nagamani M, Urban RJ. The relationships between testosterone, body composition, and insulin resistance: a lesson from a case of extreme hyperandrogenism. Diabetes Care 2005; 28:429-32. [PMID: 15677808 PMCID: PMC3174777 DOI: 10.2337/diacare.28.2.429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Elena Volpi
- Division of Geriatric Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0460, USA. evolpi@utmb
| | | | | | | | | | | | | |
Collapse
|
12
|
Lemieux S, Lewis GF, Ben-Chetrit A, Steiner G, Greenblatt EM. Correction of hyperandrogenemia by laparoscopic ovarian cautery in women with polycystic ovarian syndrome is not accompanied by improved insulin sensitivity or lipid-lipoprotein levels. J Clin Endocrinol Metab 1999; 84:4278-82. [PMID: 10566685 DOI: 10.1210/jcem.84.11.6140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is a common disorder associated with hyperandrogenemia and infertility. Abdominal obesity, insulin resistance, and dyslipoproteinemias are other common metabolic disorders typically found in women with PCOS. The cause-effect relationship between hyperandrogenemia and insulin resistance-dyslipoproteinemia remains unclear. In this study, we have investigated the changes in androgenemia, insulin sensitivity, and plasma lipid-lipoprotein levels after laparoscopic ovarian cautery (LOC) for ovulation induction in eight infertile women with clomiphene citrate-resistant PCOS. After LOC, significant decreases in androstenedione (43%), testosterone (48%), and free testosterone (48%) concentrations were observed (P < 0.05). Glucose utilization during an euglycemic-hyperinsulinemic clamp did not change after LOC. In addition, no significant changes after the surgical procedure were observed for cholesterol, triglycerides, and apolipoprotein concentrations measured in total plasma and in different lipoprotein fractions. In conclusion, within the short duration of observation of this study, our findings demonstrate that insulin resistance and lipoprotein abnormalities associated with PCOS are not secondary to hyperandrogenemia. The clinician, therefore, must be cognizant of the persistence of these metabolic risk factors for cardiovascular disease once successful ovulation and fertility is restored, and institute appropriate monitoring, counseling, and medical intervention as required.
Collapse
Affiliation(s)
- S Lemieux
- Department of Medicine and Physiology, The Toronto Hospital (General Division), University of Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
13
|
Pfeifer SL, Wilson RM, Gawkrodger DJ. Clearance of acanthosis nigricans associated with the HAIR-AN syndrome after partial pancreatectomy: an 11-year follow-up. Postgrad Med J 1999; 75:421-2. [PMID: 10474728 PMCID: PMC1741275 DOI: 10.1136/pgmj.75.885.421] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We describe a woman with the syndrome characterised by hyperandrogenism, insulin resistance and acanthosis nigricans (the HAIR-AN syndrome), and an associated insulinoma (islet B-cell tumour), whose signs and symptoms cleared after partial pancreatectomy.
Collapse
|
14
|
Gjønnaess H. Comparison of ovarian electrocautery and oral contraceptives in the treatment of hyperandrogenism in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 1999; 78:530-3. [PMID: 10376864 DOI: 10.1080/j.1600-0412.1999.780610.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Endocrine treatment of hyperandrogenism in women with polycystic ovary syndrome (PCOS) aims at reduction of androgens and increasing sex hormone binding globuline (SHBG), which are also side effects of ovarian electrocautery (OE) when used for induction of ovulation. METHODS Hormonal effects of ovarian electrocautery were compared with the effects of oral contraceptives (OC) containing desogestrel (DG) or cyproteron acetate (CPA). OCs were given to 18 women with PCOS as their sole treatment (group A) and to 23 women after the restoration of regular ovulatory cycling by ovarian electrocautery (group B). RESULTS Ovarian electrocautery induced ovulation and increased the concentration of estrogens and especially progesterone, while OC induced the opposite effects. In the androgens and SHBG the two treatments induced changes that were in the same direction, but OC treatment induced changes that exceeded those of OE. The concentration of SHBG increased from 27.9 to 127.7 nmol/L on OC treatment (Group A), compared with 37.2 to 44.9 after OE (Group B). The androgens decreased, for testosterone the decreases were 2.1 and 0.99 nmol/L, respectively, for androsterone 5.36 and 3 nmol/L, for dihydrotestosterone 0.12 and 0.1 nmol/L, and for DHEAS 3.28 and 1.8 umol/L. No further gain was obtained by the combination of the two treatments. CONCLUSIONS Hyperandrogenism in women with PCOS can be effectively treated with OCs containing DG or CPA. In women with concurrent infertility, however, ovarian electrocautery can be recommended. The only indication for the combination of these two treatments is ambivalence with regard to the fertility after ovulation induction by OE. A temporary delay of ovulatory cycling with OC-treatment after OE has no negative impact upon the future fertility.
Collapse
Affiliation(s)
- H Gjønnaess
- Gynecology and Obstetrics Department, Aker University Hospital, Oslo, Norway
| |
Collapse
|
15
|
Manieri C, Di Bisceglie C, Fornengo R, Grosso T, Zumpano E, Calvo F, Berardengo E, Volante M, Papotti M. Postmenopausal virilization in a woman with gonadotropin dependent ovarian hyperthecosis. J Endocrinol Invest 1998; 21:128-32. [PMID: 9585388 DOI: 10.1007/bf03350327] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We report a case of a 66-yr-old woman with progressive hair balding, hirsutism and virilization. Gonadotropins and estradiol levels were in the postmenopausal range; total testosterone (TT), free testosterone (FT) and 17-hydroxyprogesterone (17-OHP) were elevated with dehydroepiandrosterone sulphate, androstendione and cortisol serum levels in the normal range, as 24-hr free urinary cortisol. TT, FT and 17-OHP were normalized, and FSH and LH fell to premenopausal levels on 18th day after a single i.m. injection of the GnRH analogue (GnRHa), triptorelin. Then, a diagnosis of hyperandrogenism of ovarian origin was made and bilateral ovariectomy was performed. Histological study of gonadal tissue revealed diffuse stromal hyperplasia of both ovaries with occasional nests of luteinized cells. With immunoperoxidase techniques these cells stained positively for testosterone and progesterone. One month after surgery, androgen levels were normalized together with regression of most of the clinical signs of virilization. In conclusion, our patient showed a severe virilization developed after menopause; hormonal investigations suggested a gonadotropin dependent ovarian hyperandrogenism, confirmed by histological examination; the presence of luteinized cells in the ovarian stroma was responsible for hyperandrogenism, as confirmed by the immunoperoxidase technique.
Collapse
Affiliation(s)
- C Manieri
- Dipartimento di Medicina Interna, University of Torino, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Kaaijk EM, van der Veen F, Beek JF, van Gemert MJ, Lammes FB. Transvaginal interstitial laser treatment of the ovary for the management of chronic hyperandrogenic anovulation: first clinical experience. Gynecol Obstet Invest 1997; 44:115-9. [PMID: 9286725 DOI: 10.1159/000291500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The feasibility of ultrasound-guided transvaginal interstitial laser treatment of the ovary (TILT) and its efficacy for ovulation induction was investigated in 3 hormone-therapy-resistant patients with chronic hyperandrogenic anovulation. TILT was performed at powers of 1-2 W and exposures of 75-600 s. Clear-cut hyperechogenic zones developed during laser irradiation with diameters of up to 13.7 mm. Spontaneous ovulation and/or hormonal changes after TILT did not occur. No adhesion formation was seen during a laparoscopy or laparotomy in 2 patients 6 months after TILT. In conclusion, TILT of the ovaries was simple to perform but so far the clinical results are disappointing. Further studies with a modified technique are necessary to further investigate the efficacy of TILT.
Collapse
Affiliation(s)
- E M Kaaijk
- Center of Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
17
|
Abstract
BACKGROUND AND OBJECTIVE Interstitial laser treatment (ILT) of the ovary might be a new surgical approach to restore ovulation with a minimal risk of adhesion formation in patients with chronic hyperandrogenic anovulation who are unresponsive to hormone therapy. The objective was to investigate the feasibility of inducing a lesion limited to the center of the ovary in an animal model. STUDY DESIGN/MATERIALS AND METHODS ILT was performed in seven goats using Nd:YAG laser in combination with ultrasound monitoring. The extent of direct thermal damage was investigated in two goats, treating both ovaries during a laparotomy at 2, 4, 6, and 8 W, respectively, for 5 min. Adhesion formation was evaluated in five goats 81 days after an unilateral laparoscopic ILT at 1, 2, 4, 6, or 8 W for 5 min. During treatment temperatures on the surface of the ovary were measured. RESULTS Histology after 1 day showed sharply demarcated necrotic lesions located centrally or subcapsularly at low powers, whereas at higher powers the lesions extended to the surface of the ovary. At low powers no adhesions were observed, whereas higher powers resulted in periovarian adhesions. Temperatures measured on the ovarian surface during treatment ranged between 38 degrees C and 90 degrees C. Ultrasound monitoring of the extent of thermal damage failed due to poor positioning. CONCLUSION Although this pilot study does not warrent firm conclusions, the results indicate that ILT of the ovary is feasible and that lesions without adhesions can be produced at low powers. The use of ultrasound to monitor the extent of thermal damage in the ovary should be a subject of further evaluation.
Collapse
Affiliation(s)
- J F Beek
- Laser Center, Academic Medical Center, Amsterdam, Netherlands
| | | | | | | | | | | | | | | |
Collapse
|