Endocrine Abstracts

We present an 83-year-old female who presented with excess body hair growth, worst on her face, arms and abdomen. This was associated with features of virilasation and weight loss. Her past medical history includes; hypertension, Temporal arteritis, Gout and duodenal ulcer disease. Her medications were Felodipine 2.5 mg OD, Captopril 25 mg BD, Bendroflumethiazide 2.5 mg OD, Aspirin 75 mg OD, Ezmoprazole 20 mg OD.

On examination, she was found to have deep voice, coarse dark hairs covering extensive areas over abdomen, arms and legs with loss of scalp hair. There were no features of Cushing’s syndrome and her BP was 152/80 mmHg. Rest of systems examination was normal.

Investigations: Testosterone 25.9 nmol/l, SHBG 33 nmol/l, LH 4.9 IU/l, FSH 18.3 IU/l, Cortisol 305 nmol/l, PRL 274 mu/l, TSH 3.16 miu/l, FT4 12.2 pmol/l, 24 h urinary cortisol normal. Her HCG, AFP, CA125, CA153, CA199, CEA, renal function, liver function and glucose were all normal. A CT scan of abdomen and pelvis, confirmed left ovarian tumour, with no other pathology. She underwent bilateral salpingo-oophrectomy. The histology confirmed Sertoli cell tumour. Post operatively her testosterone levels fell but never normalised. Unfortunately, she lost follow-up. Two years later she presented with deep voice, hirsuitism and weight loss. Systemic examination was unremarkable apart from features of hyperandrogenism. Her Serum Testosterone 6.2 nmol/l, DHEAS 16.7 umol/l, Estradiol 219 pmol/l and CA125 1209 Ku/l. A CT scan abdomen and pelvis revealed 8.5X5.5 cm mass behind the bladder extensive peritoneal and omental seeding, ascitis and liver metastasis.

Conclusion: Patients with androgen secreting ovarian tumours need regular follow-up with regular biochemical testing for evidence of complete tumour resection or recurrence. Persistent symptomatic hyper-androgenaemia post operatively is an indication of incomplete removal or disease recurrence.