Endocrine Abstracts

Introduction: High androgen levels and infertility in reproductive women, beyond the most common cause of polycystic ovary syndrome (PCOS), is often a challenge diagnosis. Ovarian steroid cell tumor is considered a rare subtype of hormone-secreting ovarian tumor, accounting for about 0.1% of all ovarian tumors.

Aim: To report a case of extremely high testosterone levels in a woman with secondary amenorrhea but without signs of virilization, and describe diagnostic assessment of testosterone levels.

Methods: Assessing true testosterone levels by three different manufacture methods Centaur (Siemens), Cobas (Roche manufacture), Architect (Abbott manufacture), respectively and extraction procedure with diethyl ether prior to immunoassay.

Case Presentation: A 27 years old woman was followed for a presumed ovarian dermoid cyst and PCOS. Two years later hormonal treatment was stopped in intention for conceive, but menstruation did not resume. Evaluation revealed extremely high testosterone level of 22.1nmol/l, (reference value <2.1 nmol/l) measured by Centaur analyzer (Siemens manufacture) without signs of virilization. Levels of SHBG, FSH and LH were within the normal range. The sample was processed by two alternative methods, Cobas (Roche manufacture) and Architect (Abbott manufacture), showing similar results for testosterone: 19.5 and 23.0 nmol/l, respectively. The same values of total testosterone were found after heterophile and nonspecific antibodies blocking test. At this point, extraction procedure with diethyl ether was performed prior to immunoassay, then testosterone was measured on Cobas/Roche analyzer. A level of 5.6 nmol/l total testosterone was found after the extraction procedure. An abdominal contrast computed tomography scan (CT) confirmed a 30 mm X 36 mm round solid mass in the left ovary, not characteristic of a dermoid cyst. The ovarian mass was resected. Histological diagnosis reveled an ovarian steroid-cell tumor (SCT) not otherwise specified (NOS). Twenty-four h after the surgery total testosterone level returned to normal range, 0.6 nmol/l. A month after surgery the patient resumed menstruation.

Conclusions: 1. Our case demonstrates that in some instances, the produced testosterone by the tumor can have a selective influence on peripheral tissues causing only menstrual irregularity without virilization. Since these tumors have malignant potential, differential diagnosis of ovarian mass with high levels of testosterone is essential even without signs of virilization. 2. Elimination of the interferences by extraction with diethyl ether demonstrated that the cause of pitfall in total testosterone level was hydro soluble fragments of the steroid hormone pathway which react with testosterone antibodies in the direct assay.