ECE2024 Eposter Presentations Reproductive and Developmental Endocrinology (78 abstracts)
Use of selective adrenal and ovarian venous sampling in postmenopausal women with severe hyperandrogenism: Report of 3 cases
Valeria Arsentales Montalva 1 , Olga Giménez-Palop 2 , Ismael Capel 2 , David Subías 2 , Ana Romero 1 , Alba Hernández 1 , Andreea Muntean 1 , Judith Jover 1 , Laura Costa 3 , Juan Perendreu 4 , Carlos García 5 & Mercedes Rigla 2
1 Endocrinology and Nutrition Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain; 2Endocrinology and Nutrition Department, Parc Taulí University Hospital, Autonomous University of Barcelona (UAB), Sabadell, Barcelona, Spain; 3Obstetrics and Ginecology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain; 4Interventional Radiology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain; 5UDIAT Laboratory Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
Background: Although the majority of cases of hyperandrogenism in postmenopausal women are due to functional causes, the sudden appearance of a severe and rapidly progressive condition, especially if associated with signs of virilization and defeminization, requires always ruling out the existence of an androgen-producing tumor at both the adrenal and ovarian levels. Etiological diagnosis can be difficult because ovarian tumors are not easily demonstrable by imaging.
Case Reports: Three postmenopausal women (mean age: 69 years) referred to our center for hirsutism and elevated testosterone levels. As relevant associated diseases: obesity, dyslipidemia and type 2 diabetes. They reported growth of facial hair, upper chest and back for the last 3-4 years, acne, seborrhea, androgenic alopecia and weight gain between 5-8 Kg. Two of them, with a history of oligomenorrhea in the reproductive age. The average Ferriman-Gallwey score was 21, without clitoromegaly. High total testosterone levels stood out in all cases, with an average figure of 1.73 ng/ml (reference value 0.03-0.41 ng/ml) and a mean free testosterone of 3.04 ng/ml (reference value 0-0.1 ng/ml). The determinations of dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone, prolactin, thyroid function, 24-hour urinary free cortisol excretion and low-dose dexamethasone suppression test were within normal limits. The transvaginal ultrasound and the pelvic MRI did not show any remarkable findings. A CT Scan of the adrenal glands showed a non-functioning left adrenal nodule (measured 25x22 mm) already known and studied, with normal (DHEAS) levels in one of the three cases, without signs of growth or formation of new lesions in any of the glands. In the absence of conclusive radiological localization of androgen hyperproduction, selective catheterization of ovarian and adrenal veins was performed under stimulation of 250 ug of ACTH. In all cases, the high gradient existing between the ovarian vein/peripheral venous blood, sustained the suspicion of excessive production of androgens of ovarian origin, laparoscopic bilateral oophorectomy being performed in all patients. The pathology showed ovarian stromal hyperplasia with bilateral hyperthecosis, as well as foci of Leydig cell hyperplasia in one case. After the surgery, there was a significant improvement in hirsutism, with normalization of testosterone levels in all cases.
Conclusion: Selective venous catheterization and hormone sampling in postmenopausal women with severe hyperandrogenism could be useful to determine the source of androgenic hyperproduction in the absence of conclusive localization with standard imaging modalities, being bilateral oophorectomy as the standard surgical technique after reproductive age.
Volume 99
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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