Chen Min, Zhou Weibin, Zhang Zhe, Zou Yuting, Li Chengjiang
Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University Department of Endocrinology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2018 Mar;97(10):e0093. doi: 10.1097/MD.0000000000010093.
The incidence of severe hyperandrogenism associated with masculinity in women is very low. While rare and difficult to diagnose, androgen secreting tumors should be suspected in women with hyperandrogenism and hirsutism, especially in the postmenopausal population. Herein we present one case of ovarian Leydig cell tumor (LCT) with markedly elevated serum testosterone levels and frank hirsutism.
A 60-year-old woman, presented with increased hair growth and androgenic alopecia and the hormonal laboratory examination showed that she had elevated serum testosterone level and normal dehydroepiandrosterone sulfate (DHEAS), androstenedione, 17- hydroxyprogesterone, cortisol and thyroid stimulating hormone (TSH).
The diagnosis of possible testosterone secreting tumor was performed when pelvic computed tomography (CT) and magnetic resonance image (MRI) showed a right adnexal mass of 15mm×16mm indicative of sex cord- stromal tumors.
The patient received laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy.
After operation, testosterone got back to the normal level and clinical symptoms subsided.
It is common that postmenopausal androgen excess is a state of relative or absolute androgen excess originating from the adrenal gland and/or ovaries. In either case, doctors need to assess such patients and exclude relatively rare potential causes of tumors. Any woman who has hirsutism or frank evidence of markedly increased testosterone should exclude this kind of possibility of androgen producing tumors. It is possible to determine the origin of androgen hypersecretion with the severity of symptoms, the extent of androgen excess, and the relevant imaging studies. Since LCT are rare ovarian sex-cord stromal tumors, it can be beneficial for diagnosis with careful research of patient history of the defeminization followed by virilization, and a CT and MRI image.
女性中与男性化相关的严重高雄激素血症的发生率非常低。雄激素分泌肿瘤虽然罕见且难以诊断，但对于患有高雄激素血症和多毛症的女性，尤其是绝经后人群，应怀疑有此类肿瘤。在此，我们报告一例卵巢莱迪希细胞瘤（LCT），其血清睾酮水平显著升高且伴有明显多毛症。
一名60岁女性，出现毛发增多和雄激素性脱发，激素实验室检查显示其血清睾酮水平升高，而硫酸脱氢表雄酮（DHEAS）、雄烯二酮、17-羟孕酮、皮质醇和促甲状腺激素（TSH）正常。
盆腔计算机断层扫描（CT）和磁共振成像（MRI）显示右侧附件区有一个15mm×16mm的肿块，提示性索间质肿瘤，此时进行了可能的睾酮分泌肿瘤的诊断。
患者接受了腹腔镜全腹子宫切除术和双侧输卵管卵巢切除术。
术后，睾酮恢复至正常水平，临床症状消退。
绝经后雄激素过多是一种源于肾上腺和/或卵巢的相对或绝对雄激素过多状态，这很常见。在任何一种情况下，医生都需要评估此类患者并排除相对罕见的肿瘤潜在病因。任何有多毛症或睾酮明显升高的确切证据的女性都应排除这种产生雄激素肿瘤的可能性。通过症状的严重程度、雄激素过多的程度以及相关影像学研究，有可能确定雄激素分泌过多的来源。由于LCT是罕见的卵巢性索间质肿瘤，仔细研究患者先出现女性特征减退随后出现男性化的病史以及CT和MRI图像，可能有助于诊断。
