Postmenopausal androgen-secreting ovarian tumors: challenging differential diagnosis in two cases

Abstract

Postmenopausal hyperandrogenism constitutes a very rare condition of tumoral or non-tumoral origin primarily residing either in the ovary or in the adrenal glands. We present herein two cases with this condition; one with abnormal postmenopausal genital bleeding and mild increase in facial hair, and the second with slow-developing hirsutism and virilization. Both cases shared a notorious increase in libido.

The laboratory tests showed high levels of testosterone (>100 ng/ml). A normal value of dehydroepiandrosterone sulfate and a normal cortisol level at 9 am after 1 mg of dexamethasone administered at midnight (Nugent test) made an adrenal etiology very unlikely. On the other hand, a high level of inhibine B oriented to an ovarian source. Transvaginal sonography failed to demonstrate an ovarian tumor, but an abdominal and pelvic computed tomography scan or magnetic resonance imaging detected an ovarian tumor and normal adrenal glands.

A laparoscopic oophorectomy was performed, and the histological study demonstrated a steroidal cell tumor in the first case and a Leydig cell tumor in the second.

摘要

绝经后高雄激素血症包括一类非常罕见的肿瘤或非肿瘤起源的情况, 主要存在于卵巢或肾上腺内。我们在此提出两例这种情况：1例出现绝经后异常生殖器出血和面部毛发轻度增多, 第2例出现发展缓慢的多毛和女性男性化表现。这两例患者都存在明显的性欲增加。 实验室检查提示睾酮升高(>100 ng/ml)。在夜间给予1毫克地塞米松后第二天上午9点检查脱氢表雄酮硫酸盐和皮质醇水平均正常(Nugent测试)而排除了肾上腺疾病。另一方面, 抑制素B升高说明疾病为卵巢来源。经阴道超声检查并未检测到卵巢肿瘤, 但是经腹部盆腔计算机断层扫描或核磁共振成像检测到了卵巢肿瘤以及正常的肾上腺。经过腹腔镜卵巢切除手术, 组织学检查显示第一例为类固醇细胞肿瘤, 第二例为睾丸间质细胞瘤。

Keywords:

• Menopause
• hyperandrogenism
• ovarian tumor
• virilization
• Leydig cell tumor
• steroidal cell ovarian tumor

Conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

Nil.