title: Ovarian Leydig cell tumor in a peri-menopausal woman with severe hyperandrogenism and virilization.
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. Transabdominal 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.
authors.affiliation: Academic Unit of Obstetrics, Gynaecology and Reproductive Health, St Mary's Hospital, Manchester, UK. luciano.nardo@cmmc.nhs.uk
authors.forename: L G
authors.initials: LG
authors.lastname: Nardo
authors.forename: D W
authors.initials: DW
authors.lastname: Ray
authors.forename: I
authors.initials: I
authors.lastname: Laing
authors.forename: C
authors.initials: C
authors.lastname: Williams
authors.forename: R J
authors.initials: RJ
authors.lastname: McVey
authors.forename: M W
authors.initials: MW
authors.lastname: Seif
mesh_terms: D000728:Androgens / Q000097:blood; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications*; D007044:Hysterectomy; D007984:Leydig Cell Tumor / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D010052:Ovariectomy; D010053:Ovary / Q000098:blood supply; D013739:Testosterone / Q000097:blood; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014680:Veins; D014770:Virilism / Q000150:complications*
chemical_list: D000728:Androgens; D013739:Testosterone