Endocrine Abstracts

Testosterone has a dose-dependent stimulatory effect on erythropoiesis but the mechanism is poorly understood. Although both erythroblasts and megakaryocytes express androgen receptors, testosterone’s effect on thrombopoiesis in humans has never been studied.

We report a case of 53-years-old woman presented with androgenic alopecia, hirsutism, facial redness and hoarse voice. She was a non-smoker and had a history of well-controlled diabetes mellitus type 2. Endocrinological evaluation disclosed total serum testosterone level of 34.8 nmol/l (normal range 0.1–1.4), free serum testosterone of 693 pmol/l (normal range 1–33) and suppressed FSH and LH levels. Blood routine samples taken on two separate occasions disclosed erythrocytosis and trombocytosis. White blood cell count, erythrocyte sedimentation rate and C-reactive protein were all within normal ranges. Abdominal and pelvic computed tomography, transvaginal ultrasonography, and pelvic magnetic resonance imaging failed to localize tumor. Normal dehydroepiandrosterone-sulphate levels indicated ovarian origin of hypertestosteronemia. Therefore, laparoscopic bilateral ovariectomy was performed. Focal tumor mass was not found on macroscopic examination. Microscopic examination disclosed a part of tumor tissue in the hilus of the left ovary. Tumor mass was torn apart and cauterized during surgery and therefore it is true size could not be measured. Tumor tissue stained positively for inhibin and calretinin and the diagnosis of hilus Leydig cell tumor was established. Testosterone level decreased to 1.7 nmol/l, RBC decreased from 5.7 to 4.7×1012/l, hematocrit level from 0.520 to 0.420, haemoglobin from 170 to 141 g/l and PC decreased from 480 to 378×109/l level normalized 2 weeks after the surgery and remained normal 3 months postoperatively.

Ovarian Leydig cell tumors are rare. Their association with erythrocytosis was reported in one case and concomitant erythrocytosis and thrombocytosis have never been reported. Substantial, immediate and persistent decrease in both RBC and PC after tumor removal suggests testosterone’s synergistic effect on erythropoiesis and thrombopoiesis. Further studies are worthy.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.