Ovarian Leydig cell tumor in a peri-menopausal woman with severe hyperandrogenism and virilization

L. G. Nardo, D. W. Ray, I. Laing, C. Williams, R. J. McVey, M. W. Seif

    Research output: Contribution to journalArticlepeer-review

    Abstract

    The authors report a case of Leydig cell tumor in a 46-year-old woman who first presented with severe clinical hyperandrogenism and associated complex medical history. Investigations revealed markedly raised serum concentrations of testosterone (28.3 nmol/l) and free androgen index (54.4), whereas sex hormone binding globulin, random cortisol, androstenedione, 17-hydroxyprogesterone and dehydroepiandrosterone sulphate concentrations were all within the normal range. Trans abdominal ultrasound and computed tomography scan of the pelvis and abdomen showed a slightly bulky right ovary, but no other abnormalities. An ovarian source of androgens was suspected and surgery was arranged. Following a three-year history of defaulting appointments due to agoraphobia, she underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and intraoperative selective ovarian venous sampling. Histopathological examination revealed a 2 cm Leydig cell tumor within the right ovary. Successful intraoperative ovarian venous sampling demonstrated significantly elevated testosterone levels (> 260 nmol/l) from the right ovarian vein. Hyperandrogenaemia normalized post-operatively. The patient showed significant regression of clinical signs and symptoms, including the anxiety disorder. Clinical presentation, biochemistry and imaging modalities should allow to detect androgen-secreting ovarian tumors, while selective venous sampling should be reserved for patients whom uncertainty remains. The present case confirms that androgen-secreting ovarian tumors represent a diagnostic and therapeutic challenge. They have to be considered in the differential diagnosis of severe hyperandrogenism even in peri-menopausal women. Although selective venous sampling is of diagnostic value, however, its impact on future management should be considered on individual basis. © 2005 Taylor & Francis.
    Original languageEnglish
    Pages (from-to)238-241
    Number of pages3
    JournalGynecological Endocrinology
    Volume21
    Issue number4
    DOIs
    Publication statusPublished - Oct 2005

    Keywords

    • Hyperandrogenism
    • Ovarian Leydig cell tumor
    • Peri-menopause
    • Selective venous sampling
    • Virilization

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