ECE2020 ePoster Presentations Reproductive and Developmental Endocrinology (37 abstracts)
Leydig cell tumor of the ovary: a rare cause of postmenopausal virilization
Anastasia-Konstantina Sakali
,
Pinelopi Thoda
,
Dimitra Pappa
,
Eleftheria Mparmpa
,
Eleni Georgiou
,
Ioannis Gountios & Alexandra Bargiota
University Hospital of Larissa
,
Faculty of Medicine
,
University of Thessaly
,
Department of Endocrinology
,
Metabolism and Diabetes
,
Larissa
&
Greece
Introduction: Postmenopausal virilization with acute onset and rapid progression requires a thorough investigation for the presence of adrenal or ovarian tumor. We present here a challenging case of a radiologically not visible and rare androgen-hypersecreting ovarian tumor.
Case report: A 71-year old postmenopausal woman presented to our department for the investigation of terminal hair growth, of recent onset and rapid progression, on the upper lip, chin and thighs. Physical examination revealed hirsutism (Ferriman-Gallway score of 11) and signs of virilization with clitoromegaly. On hormonal evaluation she had high levels of serum testosterone (4 ng/ml), while androstenedione (Δ4-A: 1.5 ng/ml), dehydroepiandrosterone sulfate (DHEA-S: 150 µg/dl) and 17 (OH) progesterone (17 (OH) PRG: 1 ng/ml) were within nomal range. MRI imaging of the pelvis was unremarkable, while adrenal CT imaging demonstrated a small left adrenal hypodense lesion of 1 cm diameter. She underwent laparoscopic left adrenalectomy and histopathology was indicative of a non-secreting adrenocortical adenoma. Postoperatively, clinical and biochemical hyperandrogenism persisted. Subsequently, she had a laparoscopic bilateral salpingo-oophorectomy and histopathological examination revealed the presence of a small Leydig cell tumor of the right ovary of approximately 1.2 cm diameter, with no features indicating malignant potential. Postoperatively, serum testosterone levels dropped and were within normal range (0.025 ng/ml) and remain so at her 3 month follow up accompanied by clinical improvement.
Conclusion: Hyperandrogenism in the menopause may be challenging. Rapid development and the presence of virilization signs are usually indicative of a tumor of either adrenal or ovarian origin. When the tumor is radiologically not visible and the adrenal origin of the hyperandrogenism is excluded, laparoscopic oophorectomy might be needed, despite the negative radiological results. Sertoli-Leydig cell tumors are extremely rare; typically, they are unilateral and confined in the ovary. Unlike our case, most patients are premenopausal and the tumor size is large. Prognosis relies on the degree of differentiation of the tumor and is usually favorable.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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