Endocrine Abstracts

Introduction: Androgen-producing tumors are a rare cause of hyperandrogenism (±0.2%). Ovarian steroid cell tumors represent <0.1% of all ovarian tumors. They may present at any age and in 12–50% of cases are associated with virilization. The majority of these tumors are benign or low-grade malignanies.

Clinical case: A 74-year-old female patient, with history of vaginal hysterectomy for genital prolapse at the age of 50, is referred to Endocrinology consultation for androgenic alopecia, which lasted for 10 years. She also complained of irritability. Mild hirsutism, deepening of voice and clitoromegaly were noticed on physical examination. Biochemical hyperandrogenism was revealed: total testosterone 3.35 ng/ml (n: 0.1–0.8), free testosterone 0.79 ng/dl (n<0.20), dihydrotestosterone 0.36 ng/ml (n: 0.02–0, 37), delta 4-androstenedione 2.2 ng/ml (n: 0.3–3, 5), 17-hydroxyprogesterone 1.8 ng/ml (n: 0.11–1.2), DHEA-s 94 μg/dl (n: 35–410). There were no significant alterations at both ovaries on pelvic transvaginal ultrasound. Pelvic MRI revealed a 27×15 mm right adnexal mass, isointense on T1- and mildly hyperintense on T2-weighted imaging, which had not been visualized by abdominopelvic CT scans. Tumor markers were negative (CEA, CA19.9, CA125, Ca15.3, α-fetoprotein). She underwent exploratory laparotomy, which revealed adnexa with normal macroscopic appearance, and no other significant alterations in the abdominopelvic cavity. Peritoneal washing, scraping of the diaphragm and bilateral salpingo-ophorectomy were performed. Frozen section of the surgical specimen revealed a sex cord-stroma tumor in the right ovary of and areas of stromal hyperplasia on the left ovary. Diagnosis of ovarian steroid cell tumor was made by definitive histological and immunohistochemical examination. After surgery, there was improvement of the alopecia and hirsutism and androgen level normalization.

Discussion: Symptoms and signs of virilization and total testosterone levels three times the upper limit of normal or greater than 2 ng/ml are suggestive of the presence of an androgen-producing tumor. Despite the recognized value of transvaginal pelvic ultrasonography in the diagnosis of ovarian tumors, its sensitivity and specificity in the diagnosis of ovarian tumors in women with hyperandrogenism are not certain.