Adolescent ovarian thecoma presenting as progressive hyperandrogenism: case report and review of the literature

Abstract

Hyperandrogenism is frequent and under investigated in adolescent girls. A 15-year-6-month-old French girl presented with oligomenorrhea and slowly progressing virilization 2 years post-menarche. Medical history revealed prenatal pesticide exposure through maternal professional activity and recurrent premature thelarche. Severe hirsutism, mild facial acne and clitoromegaly were noted. Serum androgens (testosterone: 94 ng/dL, 4-androstenedione: 8.23 ng/mL) were high and non-classic 21-hydroxylase deficiency was excluded. Pelvic ultrasonography showed a left ovarian mass, confirmed by computed tomography scan. Tumor markers were negative. Laparoscopic surgery was performed. The pathological diagnosis was benign luteinized thecoma. Postoperatively, the menstrual cycle and serum androgens became normal and hirsutism slowly improved. Hyperandrogenism 2 years after menarche should be systematically investigated, even if slowly progressive, since it may be a symptom of a rare virilizing ovarian tumor, like thecoma.

摘要

在青春期女孩中高雄激素血症很常见, 而且仍然在研究中。一名15岁6个月大的法国女孩在初潮后2年表现出月经减少和逐渐加重的女性男性化。通过她母亲的职业和反复早产的病史发现, 她母亲在妊娠时有杀虫剂的接触史。女孩体检发现具有严重的多毛、面部痤疮和阴蒂肥大表现。血清雄激素（睾酮-1：94 ng/dL, 4-雄烯二酮：8.23 ng/dL）较高, 并且排除了非典型的21-羟化酶缺乏。盆腔超声提示左侧卵巢肿物, 经计算机断层扫描也证实肿物存在。肿瘤标记物呈阴性。女孩进行了腹腔镜手术。病理诊断为良性黄素化卵泡膜细胞瘤。术后月经周期和血清雄激素恢复正常, 多毛症逐渐好转。月经初潮后2年的高雄激素血症应该进行系统的检查, 即使进展缓慢, 因为它可能是一种罕见的男性化卵巢肿瘤的症状, 如卵泡膜细胞瘤。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Adolescent hyperandrogenism
• hirsutism
• ovarian thecoma
• endocrine disruptor chemicals

Disclosure statement

The authors have no conflict of interest to declare concerning this paper.