Nishiyama Sachie, Hirota Yutaka, Udagawa Yasuhiro, Kato Ryoichi, Hayakawa Nobuki, Tukada Kazuhiko
Department of Obstetrics and Gynecology, Fujita Health University, Toyoake, Japan.
Med Sci Monit. 2008 Feb;14(2):CS9-12.
Androgen-producing tumors, originating mostly in the ovary or adrenal gland, induce hirsutism. It sometimes is difficult to localize the tumor precisely even with modern imaging technology. We used selective venous catheterization and hormonal sampling (SVCHS) to localize an androgen-producing ovarian tumor.
A 37-year-old woman (gravida 0, para 0) presented with secondary amenorrhea, infertility, and virilization, including hirsutism and progressive balding. Laboratory examination revealed severe hyperandrogenism, with a total testosterone (T) concentration of 13.1 ng/ml and a free T concentration of 28.1 pg/ml. Dehydroepiandrosterone sulfate and androstendione were within normal ranges. Work-up included an abdominal and pelvic ultrasound scan, CT, MRI, and norcholesterol scintigraphy without discovery of the source of the hyperandrogenism. Persistently high plasma T concentrations prompted SVCHS. Eleven blood samples were collected from both the adrenal and the ovarian veins bilaterally. The total T concentration was significantly higher in blood from the right ovarian vein (878 ng/ml). A laparoscopic right oophorectomy was performed. The pathologic diagnosis was a Leydig cell tumor. A rapid decrease in free and total T followed tumor removal, and she became pregnant by in vitro fertilization.
SVCHS is highly effective in confirming the presence of a small androgen-producing ovarian tumor.
产生雄激素的肿瘤大多起源于卵巢或肾上腺，可导致多毛症。即使采用现代成像技术，有时也难以精确确定肿瘤的位置。我们采用选择性静脉插管和激素采样（SVCHS）来定位产生雄激素的卵巢肿瘤。
一名37岁女性（孕0产0）出现继发性闭经、不孕和男性化表现，包括多毛症和进行性脱发。实验室检查显示严重高雄激素血症，总睾酮（T）浓度为13.1 ng/ml，游离T浓度为28.1 pg/ml。硫酸脱氢表雄酮和雄烯二酮在正常范围内。检查包括腹部和盆腔超声扫描、CT、MRI以及去甲胆固醇闪烁扫描，但均未发现高雄激素血症的来源。持续升高的血浆T浓度促使进行SVCHS。双侧从肾上腺和卵巢静脉共采集了11份血样。右侧卵巢静脉血中的总T浓度显著更高（878 ng/ml）。进行了腹腔镜下右侧卵巢切除术。病理诊断为Leydig细胞瘤。肿瘤切除后，游离T和总T迅速下降，她通过体外受精怀孕。
SVCHS在确认存在小型产生雄激素的卵巢肿瘤方面非常有效。
