Diagnosis and resection of an oral contraceptive-suppressible Sertoli-Leydig cell tumor with preservation of fertility and a 7-year follow-up.
A 21-year-old white woman presented with virilization, hirsutism, and acne of 1.5 years' duration. Endocrine testing demonstrated complete suppression of serum testosterone, from 5.3 to 0.6 ng/mL, and serum androstenedione, from 4.7 to 1.7 ng/mL, after oral administration of 50 micrograms of mestranol and 1 mg of norethindrone for 21 days. No suppression of either steroid was produced by dexamethasone, whereas serum dehydroepiandrosterone sulfate was suppressed from 5.2 to 1.9 micrograms/mL. A left salpingo-oophorectomy was performed for a 3 x 4-cm Sertoli-Leydig cell tumor of intermediate differentiation. Intraoperative studies demonstrated that the tumor secreted testosterone, androstenedione, 17 alpha-hydroxyprogesterone, and estradiol, but not dehydroepiandrosterone sulfate. These findings support the thesis that hormonal manipulation tests cannot differentiate between adrenal and ovarian virilizing tumors. Nor does the oral contraceptive suppression of testosterone secretion exclude an ovarian malignancy. The patient remains free of recurrence after 7 years.
Haning
R V
RV
Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island.
Loughlin
J
J
Shapiro
S S
SS
D000328:Adult; D003276:Contraceptives, Oral / Q000494:pharmacology*; D003687:Dehydroepiandrosterone / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors / Q000097:blood; D019314:Dehydroepiandrosterone Sulfate; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D012739:Gonadal Steroid Hormones / Q000097:blood; D006628:Hirsutism / Q000209:etiology; D006801:Humans; D007984:Leydig Cell Tumor / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D007986:Luteinizing Hormone / Q000097:blood; D010051:Ovarian Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D010052:Ovariectomy; D013739:Testosterone / Q000037:antagonists & inhibitors* / Q000097:blood
D003276:Contraceptives, Oral; D012739:Gonadal Steroid Hormones; D013739:Testosterone; D003687:Dehydroepiandrosterone; D019314:Dehydroepiandrosterone Sulfate; D007986:Luteinizing Hormone