From diagnosis to treatment of androgen-secreting ovarian tumors: a practical approach

Abstract

About 5% of all ovarian tumors develop some form of hormonal activity. Only 1% of ovarian tumors will secrete androgens causing clinical hyperandrogenism. Most androgen-secreting neoplasms (ASN) derive from sex cord or stroma cells of the ovary and may affect both premenopausal and postmenopausal women. Typically, a patient will present reporting symptoms of rapidly increasing hyperandrogenization such as: hirsutism, acne, frontal/male pattern balding, and in severe cases even virilization. Sertoli-Leydig Cell Tumors are the most frequent ASN and constitute about 0.5% of all ovarian neoplasms. Typically affecting women under 30 years of age, these tumors are usually unilateral and benign. They are also the most common tumor in postmenopausal women suffering with hyperandrogenism. Other tumors originating from the sex-cord stroma are also known to develop in this population, but the incidence of these is much lower. Approaching suspected hyperandrogenemia and its related symptoms in a clinical setting can be a significant diagnostic challenge. When evaluating a patient for hyperandrogenism, it is important to assess the severity of symptoms but most of all it is critical to assess the time of onset and dynamics of symptom progression. Diagnostic tools including laboratory tests and imaging studies should also be engaged. When deriving a differential diagnosis for androgen-secreting ovarian tumors, adrenal gland tumors should be considered as well as typical endocrine pathologies including polycystic ovary syndrome, congenital adrenal hyperplasia, Cushing’s disease, and acromegaly. Treatment options for an androgen-secreting ovarian tumors is mainly surgical, but in exceptional cases can involve pharmacotherapy alone.

摘要

大约5%的卵巢肿瘤会产生某种形式的激素活性，只有1%的卵巢肿瘤会分泌雄激素，导致临床高雄激素血症。大多数雄激素分泌肿瘤（androgen-secreting neoplasms, ASN）起源于卵巢的性索或间质细胞，可能影响绝经前后女性。通常，患者会报告高雄激素症状迅速增加，比如多毛症、痤疮、额叶/男性型秃顶，严重时甚至出现男性化。支持间质细胞瘤是最常见的ASN，约占所有卵巢肿瘤的0.5%，通常见于30岁以下的女性，通常是单侧的良性肿瘤，高雄激素血症的绝经后女性最常见的肿瘤也是支持间质细胞瘤，也有起源于性索间质的肿瘤，但发病率要低得多。临床上识别怀疑的高雄激素血症及相关症状是一个挑战，在评估患者高雄激素血症时，评估症状的严重程度很重要，但最重要的是评估发病时间和症状进展，还需要借助诊断工具，如实验室检测和影像学检查。在对分泌雄激素的卵巢肿瘤进行鉴别诊断时，应考虑肾上腺肿瘤，以及典型的内分泌疾病，包括多囊卵巢综合征、先天性肾上腺增生、库欣病和肢端肥大症。分泌雄激素的卵巢肿瘤的治疗选择主要是外科手术，但在特殊情况下可能需要单独的药物治疗。

Keywords:

• Androgen-secreting ovarian tumor
• hyperandrogenemia
• sex cord-stromal tumors

关键词:

• 分泌雄激素卵巢肿瘤
• 高雄激素血症
• 性索间质肿瘤

Disclosure statement

No potential conflict of interest was reported by the author(s).

Funding

The author(s) reported there is no funding associated with the work featured in this article.