VCOM Research Day Program Book 2023
Medical Resident Research Case Reports
17 Androgen Secreting Ovarian Tumor - A Rare Cause Of Hyperandrogenism in Women of Reproductive Age
Varsha Reddy, MD; Michelle Orlowski, DO; Dar, Suhail MD Corresponding author: firstname.lastname@example.org
Virginia Tech Carilion Clinic Division of Endocrinology Carilion Roanoke Memorial Hospital Roanoke
Hyperandrogenism is a condition that affects approximately 5-10% of women of reproductive age.1 While there are many causes, one rare etiology is a primary androgen secreting ovarian tumor, which accounts for 1% of all ovarian tumor cases and is the cause of 0.2% of hyperandrogenism cases.2,3 We report a case of a 46-year-old female who was evaluated in the emergency department on multiple occasions due to persistent cough, shortness of breath, chest discomfort, and abdominal pain. During these visits a workup included a CTA chest and CT abdomen/pelvis, which were notable for bilateral pleural effusions of unknown etiology, a 13.5 cm left pelvic mass, and an enlarged uterus. She was subsequently evaluated by Gynecological Oncology due to these findings, where she reported a history of irregular menstrual cycles followed by amenorrhea at the age of 36, hirsutism, increasing abdominal girth over the course of several years, and right breast discharge. Physical exam demonstrated acne, significant hirsutism, and clitoromegaly consistent with hyperandrogenism. Lab work was significant for an elevated total testosterone of 3,400 (2-45 ng/dL),
DHEA-S of 315 (19-231 mcg/dL), estradiol of 348 (postmenopausal <0.5-138 pg/mL), 17-OHP of 18,126 (postmenopausal = 45ng/dL), and a prolactin of 103 (postmenopausal 2-20 ng/mL). These findings prompted further workup with a MRI brain notable for a 0.9 x 0.4 x 0.4 cm pituitary microadenoma and a MRI pelvis redemonstrating a 12.0 x 9.4 x 8.8 cm left adnexal mass most likely of ovarian origin and an enlarged 22.4 x 13.4 x 12.3 cm uterus with signs of fibroids and adenomyosis. Tumor markers were obtained and notable for an elevated CA-125 of 102 (<35 U/mL) and a normal AFP and CEA. Given these findings were concerning for ovarian carcinoma, she was scheduled for exploratory laparotomy for tumor resection. She underwent hysterectomy with removal of her cervix, uterus, bilateral fallopian tubes, and left ovary. Omental specimen and pelvic washings were also obtained. Repeat total testosterone decreased to 531 ng/dL and 17-OHP decreased to 94 ng/dL, which further supported a diagnosis of a primary androgen secreting ovarian tumor. This was further confirmed with surgical pathology of her left ovary with findings consistent with a steroid cell tumor.
Reference Yildiz BO. Diagnosis of hyperandrogenism: clinical criteria. Best Pract Res Clin Endocrinol Metab. 2006 Jun;20(2):167-76. doi: 10.1016/j.beem.2006.02.004. PMID: 16772149. Rivera-Arkoncel ML, Pacquing-Songco D, Lantion-Ang FL. Virilising ovarian tumour in a woman with an adrenal nodule. BMJ Case Rep. 2010 Dec 14;2010:bcr0720103139. doi: 10.1136/ bcr.07.2010.3139. PMID: 22802276; PMCID: PMC3029143. Rojewska P, Meczekalski B, Bala G, Luisi S, Podfigurna A. From diagnosis to treatment of androgen-secreting ovarian tumors: a practical approach. Gynecol Endocrinol. 2022 Jul;38(7):537 542. doi: 10.1080/09513590.2022.2083104. Epub 2022 Jun 1. PMID: 35647677.
Made with FlippingBook Digital Proposal Maker