Endocrine Abstracts

Rare causes of severe androgen excess (AE) can present a diagnostic challenge to endocrinologists. Imaging may not identify occult ovarian pathology, and the detection of adrenal nodular disease may be indicative of incidental pathology. GnRH analogues can be used both as a medical treatment and as a diagnostic utility to confirm ovarian source, particularly in women with a preferential elevation of serum testosterone (T). In this case series, we present three cases highlighting the dual clinical applications of GnRH analogues. Case 1: Diagnostic Utility of GnRH Analogues 68-year-old female presenting with a four-year history of symptoms suggestive of severe AE with virilisation and T of 50 nmol/l (0-1.7). Following GnRH administration, T was completely suppressed, indicating a benign ovarian process. She was referred for surgery based on ultrasound findings of an ovarian mass. Histology confirmed a benign ovarian steroid cell tumour. Case 2: Therapeutic Application of GnRH Analogue 25-year-old female with severe insulin resistance syndrome due to acquired partial lipodystrophy presented clinically and biochemically with severe AE. After administration of triptorelin 3 mg, androgens were completely suppressed with significant clinical improvement in symptoms. She continues on maintenance GnRH therapy with add-back oestrogen and progesterone. Case 3: Combining Diagnostic & Therapeutic Application of GnRH Analogue 67-year-old presenting with a 15-year history of symptoms of postmenopausal AE without virilisation. A non-contrast adrenal CT showed a nodule. However, a GnRH suppression test confirmed ovarian aetiology. The patient wished to avoid surgery and proceeded with a therapeutic trial of GnRH and subsequent long-term use. This resulted in a significant improvement in symptoms. GnRH analogues desensitise and downregulate the gonadotrophs in the pituitary gland, inhibiting oestrogen and androgen secretion. GnRH analogue suppression is an important clinical tool that improves diagnostic accuracy as well as symptom burden for women with severe AE due to ovarian disease.