Selective venous catheterization in the evaluation of hyperandrogenism.
Retrograde bilateral ovarian-adrenal vein catheterization was carried out in 16 patients with plasma testosterone levels exceeding 1.4 ng/ml (4.85 nmol/l). While pelvic ultrasonography and computerized axial tomographic scan failed to locate the androgen-producing ovarian tumors, catheterization led to a diagnosis of occult ovarian tumor in 5 patients, based on the observation of an abnormally-high and unilateral ovarian-peripheral vein testosterone gradient, which was subsequently confirmed histopathologically. In one case, unilateral elevation of the adrenal-peripheral vein testosterone gradient was found, complementing the ultrasonographic finding of an adrenal mass and confirming the diagnosis of a virilizing adrenal tumor. In the other 10 patients, gradient analysis ruled out an androgen-producing tumor, leading to the identification of nontumoral hyperandrogeny, such as a severe form of the polycystic ovary syndrome in the 6 premenopausal patients and of ovarian stromal and hilus cell hyperplasia in the 4 menopausal patients. In conclusion, appropriate indication of selective catheterization may considerably reduce the need for exploratory surgery and may help in selecting the adequate surgical approach.
Bricaire
C
C
Department of Endocrinology and Reproductive Medicine, Hôpital Necker, France.
Raynaud
A
A
Benotmane
A
A
Clair
F
F
Paniel
B
B
Mowszowicz
I
I
Wright
F
F
Moreau
J F
JF
Kuttenn
F
F
Mauvais-Jarvis
P
P
D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000175:diagnosis; D000311:Adrenal Glands / Q000098:blood supply / Q000000981:diagnostic imaging; D000328:Adult; D000728:Androgens / Q000378:metabolism*; D002404:Catheterization / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis; D010053:Ovary / Q000098:blood supply / Q000000981:diagnostic imaging; D013739:Testosterone / Q000097:blood; D014463:Ultrasonography; D014770:Virilism / Q000097:blood / Q000175:diagnosis*
D000728:Androgens; D013739:Testosterone