title: Virilization due to androgen hypersecretion in a patient with ovarian leydig cell tumor: diagnostic and psychosocial implications.
abstract: Virilization due to hyperandrogenism in women causes male signs and symptoms such as swelling of the clitoris, deepening of the voice, facial hair and increase in body hair. Virilization is caused by less than 0.5% of all ovarian tumors. Here we report a case of virilizing Leydig cell tumor of the left ovary in a 36 year old woman. Misinterpretation of symptoms, conflicting medical information and advice from previous doctors had confused the patient. We performed a diagnostic evaluation including clinical, hormonal parameters, imaging, anatomical pathology examinations, and psychological assessment. Blood analysis showed a high testosterone level. The presence of an ovarian tumor was confirmed by laparoscopy. Since the patient refused ovariectomy, a biopsy of the left ovary was performed. Pathology showed a Leydig cell tumor without histological signs of malignancy. In spite of extensive explanation and psychological counseling, cultural barriers prevented appropriate treatment. An ovarian Leydig cell tumor should always be considered for a woman in the reproductive age with symptoms of virilization. The diagnosis is suspected on the basis of an ovarian mass on examination and further investigation and should be proven by biopsy.
authors.affiliation: Department of Pediatrics, Erasmus University MC-Sophia Children's Hospital. Rotterdam, The Netherlands. zulfa_juniarto@yahoo.com
authors.forename: Achmad Z
authors.initials: AZ
authors.lastname: Juniarto
authors.forename: Bestari A
authors.initials: BA
authors.lastname: Setiawati
authors.forename: Annastasia
authors.initials: A
authors.lastname: Ediati
authors.forename: Yvonne G
authors.initials: YG
authors.lastname: van der Zwan
authors.forename: Leendhert H J
authors.initials: LH
authors.lastname: Looijenga
authors.forename: Frank H
authors.initials: FH
authors.lastname: de Jong
authors.forename: Arianne
authors.initials: A
authors.lastname: Dessens
authors.forename: Stenvert L S
authors.initials: SL
authors.lastname: Drop
authors.forename: Sultana M H
authors.initials: SM
authors.lastname: Faradz
mesh_terms: D000328:Adult; D000728:Androgens / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D006801:Humans; D007984:Leydig Cell Tumor / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000523:psychology; D010051:Ovarian Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000523:psychology; D014770:Virilism / Q000209:etiology* / Q000378:metabolism
chemical_list: D000728:Androgens; D015415:Biomarkers