Endocrine Abstracts

Case report: A 52-year-old woman presented with an 11-month history of increasing hirsutism and deepening voice. She had a past history of total abdominal hysterectomy (ovaries preserved) with adjuvant chemotherapy and radiotherapy for cervical carcinoma. She was on no medication. Examination revealed evidence of virilisation with no other abnormality.

Investigations: Total testosterone=10.7 nmol/l (<2.9).

FSH=31.7 U/l (37–125).

Androstenedione=6.8 nmol/l (3.5–14).

LH=35.5 IU/l (10.5–42).

DHEAS=3.9 μmol/l (0.9–11.6).

E2=229 pmol/l.

Renal and liver function normal.

17-αOHP=4.7 nmol/l.

Overnight dexamethasone suppression test normal.

CT abdomen and pelvis showed normal adrenals with no ovarian mass but a ‘soft tissue mass’ (2.0×2.5 cm) was identified in the region of the proximal ascending colon. Barium enema showed a persistent indentation in the bowel wall in mid ascending colon but colonoscopy was normal. An Octreotide spect CT scan revealed tracer uptake in the region of ascending/transverse colon with more marked uptake in right iliac fossa. Review of her gynaecology surgical notes revealed preservation of the right ovary with transposition to the right paracolic gutter (removing it from the field of subsequent radiotherapy). Further review of the imaging suggested a tumour within the transposed ovary.

Treatment: At laparotamy, the right ovary (4.0×2.0×1.5 cm) was identified in the right paracolic gutter and removed. Histology revealed a steroid cell tumour without capsular invasion (mixture of leydig-like (predominant) and adrenal cortical like cells with mild atypia). Serum testosterone normalised post-operatively (1.4 nmol/l) and symptoms improved.

Discussion: Rapid onset of virilisation in a post-menapausal woman is usually due to androgen secreting tumour of adrenal or ovarian origin. In our patient, initial investigations were suggestive of a testosterone producing ovarian tumour but transposition of ovarian tissue during previous surgery created diagnostic difficulty. Endocrinologists should be aware of this aspect of gynaecological practice.