AP-HP, Department of Endocrinology and Reproductive Medicine, Groupe Hospitalier Pitié-Salpêtrière, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Université, Pierre et Marie Curie, Paris VI, 75013 Paris, France.
Eur J Endocrinol. 2011 Nov;165(5):779-88. doi: 10.1530/EJE-11-0542. Epub 2011 Sep 6.
Evaluation of postmenopausal women with suspicion of androgen-secreting tumor.
We retrospectively studied 22 postmenopausal women referred to our center for suspicion of androgen-secreting tumor. All patients had clinical, biological, and morphological evaluation. In absence of adrenal tumors, ovarian surgery was most often proposed and immunohistochemistry (IHC) studies were performed.
Ovarian tumors were detected by ultrasound and/or magnetic resonance imaging in eight patients. Two adrenal androgen-secreting tumors were diagnosed by an adrenal computed tomography (CT) scan. The clinical presentation of the women with or without tumors was similar. Nevertheless, women with tumor exhibited significantly higher testosterone levels and lower basal FSH and LH levels than the other women (2.6±2.7 vs 0.9±0.9 ng/ml, P<0.05; 26.5±22.9 vs 66.5±26.0 IU/l, P<0.01; and 12.0±8.6 vs 24.1±8.9 IU/l, P<0.05 respectively). Based on a likelihood ratio test, patients with a tumor had 8.4 and 10.8 times higher risk of having a testosterone level ≥1.4 ng/ml or an FSH level ≤35 IU/l. Finally, IHC analysis with an anti-P450c17α antibody allowed the identification of an elevated number of ovarian androgen-producing cells in five patients in whom no tumor was found.
Androgen-secreting tumors are clinically difficult to discriminate from other causes of postmenopausal hyperandrogenism. Testosterone and FSH were the two discriminative markers in a multivariate analysis. Ovarian and adrenal tumors were detected by imaging studies. However, ovarian non-tumoral causes of hyperandrogenism may be difficult to detect with conventional histology.
评估疑似分泌雄激素的肿瘤的绝经后妇女。
我们回顾性研究了 22 名因疑似分泌雄激素的肿瘤而转至我们中心的绝经后妇女。所有患者均进行了临床、生物学和形态学评估。在没有肾上腺肿瘤的情况下，通常会提出卵巢手术的建议，并进行免疫组织化学（IHC）研究。
8 名患者通过超声和/或磁共振成像发现卵巢肿瘤。2 例肾上腺雄激素分泌肿瘤通过肾上腺计算机断层扫描（CT）诊断。有肿瘤和无肿瘤的女性临床表现相似。然而，肿瘤女性的睾酮水平显著更高，基础 FSH 和 LH 水平显著更低（2.6±2.7 对 0.9±0.9ng/ml，P<0.05；26.5±22.9 对 66.5±26.0IU/l，P<0.01；12.0±8.6 对 24.1±8.9IU/l，P<0.05）。基于似然比检验，有肿瘤的患者睾酮水平≥1.4ng/ml 或 FSH 水平≤35IU/l 的风险分别增加 8.4 和 10.8 倍。最后，使用抗 P450c17α 抗体的 IHC 分析可在 5 名未发现肿瘤的患者中识别出卵巢雄激素产生细胞数量增加。
雄激素分泌肿瘤在临床上难以与其他绝经后高雄激素血症的原因区分。在多变量分析中，睾酮和 FSH 是两个有区别的标志物。通过影像学研究发现卵巢和肾上腺肿瘤。然而，传统组织学可能难以检测到卵巢非肿瘤性的高雄激素血症原因。
