ECE2020 ePoster Presentations Reproductive and Developmental Endocrinology (37 abstracts)
Hyperandrogenism caused by a leydig cell tumor of the ovary: A case report
Fernando Mendonça 1 , Selma Souto 1 , Daniela Magalhães 2 , Ana Sofia Fernandes 3 , Ana Rita Coelho 4 , Raquel Portugal 4 , Vera Falcão 3 , Sara Tavares 3 , Jorge Beires 3 & Davide Carvalho 1
1Centro Hospitalar e Universitário de S. João, Department of Endocrinology, Diabetes and Metabolism, Porto, Portugal; 2Hospital da Luz, Clínica do Porto, Porto, Portugal; 3Centro Hospitalar e Universitário de S. João, Department of gynaecology, Porto, Portugal; 4Centro Hospitalar e Universitário de S. João, Department of Pathology, Porto, Portugal
Introduction: Leydig stromal cell tumors are a subtype of steroid tumors that make up to less than 0.1% of the ovarian tumors. These neoplasms can affect women from all ages but are more frequent after menopause, being usually unilateral, benign and small sized. In around 75% of cases, these tumors produce androgenic hormones, causing oligomenorrhea and virilization.
Case report: A 39-year-old woman, nulligravid, with complains regarding androgenic alopecia, acne and hirsutism, associated with weight gain for the last 8 months. She referred menstrual irregularities with oligomenorrhea after stopping taking oral contraceptive 9 months ago. The objective examination revealed an androgenic facies and alopecia, dorsocervical adiposity, acanthosis nigricans and clitoromegaly. Blood analysis revealed total testosterone 10.52 ng/ml (0.06–0.82), estradiol 41.8 pg/ml (1.3–266), androstenedione 5.13 ng/ml (0.3–3.3), DHEA-S 246.6 µg/dl (60.9–337.0), prolactin 32.7 ng/ml (4.8–23.3), LH 0.61 mUI/ml (2.4–12.6), FSH 0.87 mUI/ml (2.1–12.6), with normal thyroid function and free 24 h urinary cortisol. The gynaecological transvaginal ultrasound revealed an heterogenous solid lesion in the left ovary with 15 × 15 × 16 mm of smooth margins. A pelvic magnetic resonance showed globosity of the central stroma of the left ovary and the abdominal CT did not reveal any adrenal pathologic findings. The patient was submitted to laparoscopic left adnexectomy that proceeded without complications. A microscopic analysis of the surgical specimen revealed a Leydig cell ovarian tumor. During the follow-up medical consultations 1 month and 4 months after surgery, there was a notorious improvement of the clinical hyperandrogenism (hirsutism, androgenic alopecia), with regularization of the menstrual cycles and normalization of the serum androgens.
Conclusion: Ovarian tumors that produce androgens are a diagnostic challenge that must be considered in the differential diagnosis of severe hyperandrogenism. This case report of a woman presenting with virilization signs, shows the importance of undertaking a careful gynecological exam, followed by measurements of serum androgens and abdominopelvic imaging to exclude androgen producing tumors of the ovaries or adrenals. The virilizing tumors of the ovaries are surgically treated, usually having good prognosis.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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