Hyperthecosis: an underestimated nontumorous cause of hyperandrogenism

Abstract

Hyperthecosis is defined as the presence of nests of luteinized theca cells in the ovarian stroma. Persistent testosterone released by ovarian theca cells is unmasked postmenopausally through the loss of granulosa cell-mediated aromatization of testosterone to estradiol. Ovarian hyperthecosis (OH) usually presents with symptoms of hyperandrogenism and is often described as a severe or extreme form of Polycystic Ovary Syndrome (PCOS). Serum testosterone levels in excess of 150 ng/dl (>5.2 nmol/l) are seen in affected patients and this threshold is used to confirm a diagnosis. Treatment of hyperthecosis is multi-faceted. It addresses the attendant hyperandrogenism (hirsutism and virilization) as well as metabolic complications such as obesity and insulin resistance. Ultimately, laparoscopic bilateral salpingo-oophorectomy is definitive treatment. This remains the treatment of choice in postmenopausal women whereas treatment using GnRH agonists may be used in women of reproductive age, especially younger women. Nevertheless, if serum testosterone remains elevated despite several months of therapy with a GnRH agonist, surgery is often required for biopsy sample collection and further definitive therapy. In order to mitigate the common clinical manifestations of hyperandrogenism, anti-androgen therapy (either cyproterone acetate or spironolactone) may be used to suppress the actions of testosterone on tissues. In patients with impaired glucose metabolism and insulin resistance, Metformin should also be considered as part of treatment. Combined, such a treatment regimen will often lead to decreased ovarian androgen secretion.

卵泡膜细胞增殖症：一种被低估的非肿瘤性高雄激素血症 摘要

卵泡膜细胞增殖症是指卵巢间质有黄素化的卵泡膜细胞。绝经后卵巢由于缺失颗粒细胞介导的睾酮芳构化为雌二醇, 而导致卵泡膜细胞持久性释放睾酮。卵泡膜细胞增殖症（OH）通常表现为高雄激素血症, 常被描述为严重/极端的多囊卵巢综合征（PCOS）。患者的血清睾酮水平超过150 ng/dl（>5.2 nmol/l）, 该阈值用于确定诊断。卵泡膜细胞增殖症的治疗是多方面的, 需要治疗伴随的高雄激素血症（多毛症和男性化）以及代谢相关并发症, 如肥胖和胰岛素抵抗。通过腹腔镜下双侧输卵管-卵巢切除术是最彻底的治疗手段, 这是绝经后女性的首选治疗方法。而使用促性腺激素释放激素激动剂（GnRH-a）的治疗方法可用于育龄期女性, 尤其是年轻女性。但如果在应用GnRH-a治疗数月后血清睾酮仍然升高, 那么通常需要手术进行活检和进一步的彻底性治疗。为了减轻高雄激素血症的常见临床表现, 可以应用抗雄激素治疗（醋酸环丙孕酮或螺内酯）, 以抑制睾酮对组织的作用。对于糖代谢受损和胰岛素抵抗的患者, 二甲双胍也可以联合应用, 同时也可以减少卵巢雄激素分泌。

Keywords:

• Hyperthecosis
• hyperandrogenism
• PCOS

Disclosure statement

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