Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland.
Appletree Medical Group, Ottawa, Canada.
Gynecol Endocrinol. 2021 Aug;37(8):677-682. doi: 10.1080/09513590.2021.1903419. Epub 2021 Mar 24.
Hyperthecosis is defined as the presence of nests of luteinized theca cells in the ovarian stroma. Persistent testosterone released by ovarian theca cells is unmasked postmenopausally through the loss of granulosa cell-mediated aromatization of testosterone to estradiol. Ovarian hyperthecosis (OH) usually presents with symptoms of hyperandrogenism and is often described as a severe or extreme form of Polycystic Ovary Syndrome (PCOS). Serum testosterone levels in excess of 150 ng/dl (>5.2 nmol/l) are seen in affected patients and this threshold is used to confirm a diagnosis. Treatment of hyperthecosis is multi-faceted. It addresses the attendant hyperandrogenism (hirsutism and virilization) as well as metabolic complications such as obesity and insulin resistance. Ultimately, laparoscopic bilateral salpingo-oophorectomy is definitive treatment. This remains the treatment of choice in postmenopausal women whereas treatment using GnRH agonists may be used in women of reproductive age, especially younger women. Nevertheless, if serum testosterone remains elevated despite several months of therapy with a GnRH agonist, surgery is often required for biopsy sample collection and further definitive therapy. In order to mitigate the common clinical manifestations of hyperandrogenism, anti-androgen therapy (either cyproterone acetate or spironolactone) may be used to suppress the actions of testosterone on tissues. In patients with impaired glucose metabolism and insulin resistance, Metformin should also be considered as part of treatment. Combined, such a treatment regimen will often lead to decreased ovarian androgen secretion.
卵巢间质细胞黄素化滤泡膜细胞瘤是指卵巢间质中存在黄素化滤泡膜细胞巢。绝经后，卵巢滤泡膜细胞持续释放的睾酮，通过失去颗粒细胞介导的睾酮向雌二醇的芳香化作用而显现出来。卵巢间质细胞增生症（OH）通常表现为高雄激素血症的症状，常被描述为多囊卵巢综合征（PCOS）的严重或极端形式。受影响的患者血清睾酮水平超过 150ng/dl（>5.2nmol/l），该阈值用于确认诊断。卵巢间质细胞增生症的治疗是多方面的。它针对伴随的高雄激素血症（多毛症和男性化）以及代谢并发症，如肥胖和胰岛素抵抗。最终，腹腔镜双侧输卵管卵巢切除术是明确的治疗方法。这仍然是绝经后妇女的治疗选择，而生殖年龄妇女（尤其是年轻妇女）可使用 GnRH 激动剂治疗。然而，如果血清睾酮在 GnRH 激动剂治疗数月后仍升高，通常需要手术采集活检样本进行进一步明确的治疗。为了减轻高雄激素血症的常见临床表现，可以使用抗雄激素治疗（醋酸环丙孕酮或螺内酯）来抑制睾酮对组织的作用。对于葡萄糖代谢受损和胰岛素抵抗的患者，也应考虑将二甲双胍作为治疗的一部分。联合使用时，这种治疗方案通常会导致卵巢雄激素分泌减少。
