Case Report
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Ovaryen venlerin selektif kateterizasyonu ile tanı alan bir postmenapozal ovaryen hiperandrojenemi vakası

Year 2018, Volume: 2 Issue: 3, 374 - 376, 01.09.2018
https://doi.org/10.28982/josam.424326

Abstract

Postmenapozal dönemde hiperandrojenemi genellikle over veya adrenal bezlerdeki tümörlerle ilişkilidir. Her iki endokrin organdaki tümörlerin çapları çok küçük olduğunda görüntüleme yöntemleri tanıda yetersiz kalmaktadır. 54 yaşında postmenapozal hasta, klitoromegali ve artış gösteren hirsutizm bulguları olan hasta serum total testosteron seviyesi 294 ng/dl ile bölümümüze başvurdu. Kontrastlı bilgisayarlı tomografide (BT) adrenal bezde 1 cm çapında tümör ile uyumlu lezyon saptandı ancak manyetik rezonans (MR) ile bu bulgu teyit edilemedi. Androjen hipersekresyonunun orijininin tespit edilememesi üzerine bilateral ovaryen ve adrenal venlerin selektif venöz kateterizasyonu ve hormonal örneklemesi yapıldı. Sağ ovaryan ven total testosteron düzeyi >1009,40 ng/dl olarak bulundu. Laparoskopik histerektomi ve bilateral salpingooferektomi yapılan hastanın patoloji sonucu sağ over kaynaklı Leydin Hücreli Tümör olarak geldi. 

Bu olgu sunumunda, postmenopozal bir kadında androjen hipersekresyonu kaynağını bulunamadığında , hem ovaryen venden hem de adrenal venlerden selektif venöz kateterizasyon ve hormonal örnekleme yapmanın önemi vurgulanmaktadır.

References

  • 1. Burger HG. Androgen production in women. Fertility and Sterility. 2002;77 Suppl 4:S3-5.
  • 2. Longcope C. Adrenal and gonadal androgen secretion in normal females. Clinics in endocrinology and metabolism. 1986;15:213-28.
  • 3. Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC et al. Androgen excess in women: experience with over 1000 consecutive patients. The Journal of clinical endocrinology and metabolism. 2004;89:453-62.
  • 4. Kaltsas GA, Mukherjee JJ, Kola B, Isidori AM, Hanson JA, Dacie JE et al. Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women? Clinical endocrinology. 2003;59:34-43.
  • 5. Nishiyama S, Hirota Y, Udagawa Y, Kato R, Hayakawa N, Tukada K. Efficacy of selective venous catheterization in localizing a small androgen-producing tumor in ovary. Medical science monitor : international medical journal of experimental and clinical research. 2008;14:Cs9-12.
  • 6. Quirk JT, Natarajan N. Ovarian cancer incidence in the United States, 1992-1999. Gynecologic oncology. 2005;97:519-23.
  • 7. Varras M, Vasilakaki T, Skafida E, Akrivis C. Clinical, ultrasonographic, computed tomography and histopathological manifestations of ovarian steroid cell tumour, not otherwise specified: our experience of a rare case with female virilisation and review of the literature. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 2011;27:412-8.
  • 8. Busquets M, Gonzalez-Bosquet E, Muchart J, Rovira C, Lailla JM. Granulosa cell tumor and endometrial cancer: a case report and review of the literature. European journal of gynaecological oncology. 2010;31:575-8.
  • 9. DiSaia PJ CW. Germ cell, stromal and other ovarian tumors. In: Clinical Gynecologic Oncology, Mosby-Yearbook, 1997: p.351
  • 10. Schneider DT, Calaminus G, Harms D, Gobel U. Ovarian sex cord-stromal tumors in children and adolescents. The Journal of reproductive medicine. 2005;50:439-46.
  • 11. Young RH, Scully RE. Ovarian Sertoli-Leydig cell tumors. A clinicopathological analysis of 207 cases. The American journal of surgical pathology. 1985;9:543-69.

A case of postmenopausal ovarian hyperandrogenemia diagnosed only by selective catheterization of ovarian vein

Year 2018, Volume: 2 Issue: 3, 374 - 376, 01.09.2018
https://doi.org/10.28982/josam.424326

Abstract

Hyperandrogenemia in a postmenopausal woman is usually related to a tumor in either ovaries or adrenal glands. To differentiate between these two endocrine organs is a diagnostic challenge when the tumor size is too small to be detected with the aid of usual imaging modalities. 54 years-old postmenopausal woman with signs of virilization was referred to our institution with serum total testosteron levels of 294 ng/dl. Contrast-enhanced computed tomography (CT) revealed a lesion consistent with the tumor 1 cm in diameter in the adrenal gland and magnetic resonance imaging (MRI) could not confirm this finding. The location of androgen hypersecretion could only be determined after selective venous catheterization and hormonal sampling of both adrenal and ovarian veins. The right ovarian venous total testosterone level was found as > 1009.40 ng / dl. A right-sided ovarian Leydig cell tumor was diagnosed in the specimen of laparoscopic hysterectomy and bilateral salpingo-oopherectomy. This case report underlines the importance to carry on the search with the selective venous catheterisation and hormonal sampling from both the ovarian and the adrenal veins when there is difficulty to demonstrate the true source of androgen hypersecretion in a postmenopausal woman. 

References

  • 1. Burger HG. Androgen production in women. Fertility and Sterility. 2002;77 Suppl 4:S3-5.
  • 2. Longcope C. Adrenal and gonadal androgen secretion in normal females. Clinics in endocrinology and metabolism. 1986;15:213-28.
  • 3. Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC et al. Androgen excess in women: experience with over 1000 consecutive patients. The Journal of clinical endocrinology and metabolism. 2004;89:453-62.
  • 4. Kaltsas GA, Mukherjee JJ, Kola B, Isidori AM, Hanson JA, Dacie JE et al. Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women? Clinical endocrinology. 2003;59:34-43.
  • 5. Nishiyama S, Hirota Y, Udagawa Y, Kato R, Hayakawa N, Tukada K. Efficacy of selective venous catheterization in localizing a small androgen-producing tumor in ovary. Medical science monitor : international medical journal of experimental and clinical research. 2008;14:Cs9-12.
  • 6. Quirk JT, Natarajan N. Ovarian cancer incidence in the United States, 1992-1999. Gynecologic oncology. 2005;97:519-23.
  • 7. Varras M, Vasilakaki T, Skafida E, Akrivis C. Clinical, ultrasonographic, computed tomography and histopathological manifestations of ovarian steroid cell tumour, not otherwise specified: our experience of a rare case with female virilisation and review of the literature. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 2011;27:412-8.
  • 8. Busquets M, Gonzalez-Bosquet E, Muchart J, Rovira C, Lailla JM. Granulosa cell tumor and endometrial cancer: a case report and review of the literature. European journal of gynaecological oncology. 2010;31:575-8.
  • 9. DiSaia PJ CW. Germ cell, stromal and other ovarian tumors. In: Clinical Gynecologic Oncology, Mosby-Yearbook, 1997: p.351
  • 10. Schneider DT, Calaminus G, Harms D, Gobel U. Ovarian sex cord-stromal tumors in children and adolescents. The Journal of reproductive medicine. 2005;50:439-46.
  • 11. Young RH, Scully RE. Ovarian Sertoli-Leydig cell tumors. A clinicopathological analysis of 207 cases. The American journal of surgical pathology. 1985;9:543-69.
There are 11 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Case report
Authors

Vedat Uğurel

Mehmet Musa Aslan

Koray Elter This is me

Publication Date September 1, 2018
Published in Issue Year 2018 Volume: 2 Issue: 3

Cite

APA Uğurel, V., Aslan, M. M., & Elter, K. (2018). A case of postmenopausal ovarian hyperandrogenemia diagnosed only by selective catheterization of ovarian vein. Journal of Surgery and Medicine, 2(3), 374-376. https://doi.org/10.28982/josam.424326
AMA Uğurel V, Aslan MM, Elter K. A case of postmenopausal ovarian hyperandrogenemia diagnosed only by selective catheterization of ovarian vein. J Surg Med. September 2018;2(3):374-376. doi:10.28982/josam.424326
Chicago Uğurel, Vedat, Mehmet Musa Aslan, and Koray Elter. “A Case of Postmenopausal Ovarian Hyperandrogenemia Diagnosed Only by Selective Catheterization of Ovarian Vein”. Journal of Surgery and Medicine 2, no. 3 (September 2018): 374-76. https://doi.org/10.28982/josam.424326.
EndNote Uğurel V, Aslan MM, Elter K (September 1, 2018) A case of postmenopausal ovarian hyperandrogenemia diagnosed only by selective catheterization of ovarian vein. Journal of Surgery and Medicine 2 3 374–376.
IEEE V. Uğurel, M. M. Aslan, and K. Elter, “A case of postmenopausal ovarian hyperandrogenemia diagnosed only by selective catheterization of ovarian vein”, J Surg Med, vol. 2, no. 3, pp. 374–376, 2018, doi: 10.28982/josam.424326.
ISNAD Uğurel, Vedat et al. “A Case of Postmenopausal Ovarian Hyperandrogenemia Diagnosed Only by Selective Catheterization of Ovarian Vein”. Journal of Surgery and Medicine 2/3 (September 2018), 374-376. https://doi.org/10.28982/josam.424326.
JAMA Uğurel V, Aslan MM, Elter K. A case of postmenopausal ovarian hyperandrogenemia diagnosed only by selective catheterization of ovarian vein. J Surg Med. 2018;2:374–376.
MLA Uğurel, Vedat et al. “A Case of Postmenopausal Ovarian Hyperandrogenemia Diagnosed Only by Selective Catheterization of Ovarian Vein”. Journal of Surgery and Medicine, vol. 2, no. 3, 2018, pp. 374-6, doi:10.28982/josam.424326.
Vancouver Uğurel V, Aslan MM, Elter K. A case of postmenopausal ovarian hyperandrogenemia diagnosed only by selective catheterization of ovarian vein. J Surg Med. 2018;2(3):374-6.