Endocrine Abstracts

Introduction: Krukenberg tumour is an ovarian metastasis of G I tract cancer; Accounting for 1 to 2% of all ovarian tumours. It is usually bilateral and more common in premenopausal compared to menopausal women. Krukenberg tumours are rare but virilizing Krukenberg tumours are even rarer. We report a case of virilizing Krukenberg tumour.

A 58-year-old Caucasian lady who was diagnosed with inoperable metastatic gastric adenocarcinoma, ascites and bilateral ovarian masses. She was treated with combination chemotherapy. During the 2nd cycle of chemotherapy she complained of excess facial and body hair. She was referred to Endocrinology department for this problem.

On examination: She was unwell and had dark skin possibly due to increased pigmentation, marked increased hair growth on face, areolar, abdomen and on limbs. There was ascites but no abdominal striae.Her clitoris was found enlarged but vaginal examination was unremarkable. BP was 105/60.

Patient was treated with Spironolactone for antiandrogen effect as well as to help with ascites.Future treatment with GnRH agonist was also considered. Unfortunately patient passed away 12 months after her initial diagnosis.

Investigation: 17-OH Progesterone 54 nmol/L (<12); DHAS 3.1 umol/L (1.0–7.0); Androstenedione 30 nmol/L (3–12); Testosterone 54 nmol/L (<2.8); HCG 3.2 u/L (<2.0); FSH 8.9 iu/L & 0.4 iu/L; LH 3.4 iu/L & <0.3 iu/L; R Cortisol 348 nmol/L; Plasma ACTH 38 ng/L (<47);CA125 1373 Ku/L (<35). CA 19.9 2197 Ku/L (<33); CEA 10 ug/L (<5).

Discussion: Her gonadotrophins, especially LH was considerably low considering her postmenopausal state, suggesting feedback effect from high Testosterone, thereby ruling out LH dependent cortical stromal hyperplasia. Normal ACTH and Random Plasma Cortisol ruled out late onset congenital adrenal hyperplasia or Cushings Syndrome. Raised 17-OH Progesterone, Androstenedione, Testosterone and normal DHAS consistent with the source of origin as ovary (Krukenberg tumour) causing virilization.