Endocrine Abstracts

Introduction: Sertoli-leydig cell tumours are neoplasms of ovarian sex cord stromal cells and account for 0.5-2% of ovarian tumours with reported incidence <0.5 % of all ovarian tumours. These tumours usually manifest in women at younger age (in 75 % patients average age of onset <30). Majority of these tumours produce hormones and up to 80% of ovarian Sertoli-Leydig cell tumours can manifest with signs of virilization.

Case report: 18 year old female who presented to endocrine outpatients with secondary amenorrhoea of 6 months and raised androgens on biochemical testing. Further history revealed she had noticed change in voice for 6 months, increase in facial hair growth, reduction in breast size and enlargement of clitoris. Biochemical testing yielded high testosterone level of 8, raised FAI of 12.8, normal prolactin, HSE2 138, LH 19.4 and FSH 2.9. She had never used contraception and was not on any regular medication. Repeat hormone profile was booked from clinic along with U/S pelvis,17OH PG and DHEAS. On repeat testing testosterone levels had risen to 12.6 from 8, with FAI of 28.6, 17OH progesterone of 16.1 (0.5-4.4) and raised DHEAS of 11.1 (1.8-10). Right ovary showed multi septated ovarian cyst. Due to raised DHEAS and 17 OHPG adrenal MRI was requested and case was discussed with gynaecology. MRI adrenal was unremarkable. Patient attended A n E department with abdominal pain, repeat ultrasound and MRI pelvis was arranged which showed progressively enlarging multi cystic right ovary with increased complexity and moderate volume of pelvic fluid/ascites. She underwent laparotomy and tumour excised along with associated fallopian tube, histology examination of the mass confirmed tumour to be Sertoli-Leydig cell tumour. She is doing well at 6 months follow up with return of menstruation.

Discussion: Sertoli Leydig cell tumours are rare tumours of ovarian stromal sex cord origin. Due to low incidence of these tumours, their presentation to endocrine clinic is a rarer occurrence. Majority of ovarian sex cord stromal tumours are hormonally active and some can present without typical symptoms of abdominal pain, it is important to recognise this early and consider this as part of differential diagnosis in females with signs of virilization. Early recognition and appropriate referral ensures optimal outcome