Larrea Agustina Lucila, González Vicente Ricardo, Knoblovits Pablo, Gil Santiago José
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Rev Fac Cien Med Univ Nac Cordoba. 2021 Jun 28;78(2):193-196. doi: 10.31053/1853.0605.v78.n2.32136.
During menopausal transition, mild clinical signs of hyperandrogenism may appear as part of the normal aging process, but the development of frank virilization suggests a specific source of androgen excess. In this context, androgen-secreting tumors at both adrenal and ovarian levels should be ruled out. We present the case of a 51-year-old postmenopausal woman with signs of 12 month period virilization, associated with personal history of type 2 diabetes and arterial hypertension, poorly managed in the past year. Laboratory tests showed elevation of serum androgen levels and hyperinsulinemia. Images were requested, revealing both enlarged homogeneous and solid ovaries, with preserved adrenal glands, which led to suspicion of a possible thecal hyperplasia of the ovarian stroma. Laparoscopic bilateral adnexectomy was performed and the pathological report confirmed the presumptive diagnosis. One month later after surgery, serum testosterone levels returned to values close to spected for a postmenopausal woman. Finding the source of virilization in postmenopausal women is challenging, and they are usually associated with rare pathologies. A detailed medical history is essential to differentiate the progressive development of virilization that characterizes benign causes from the rapid progression that characterizes malignant tumors. The adequate interpretation of laboratory tests with complementary images, as well as looking for the association of pathologies causing elevated cardiovascular risk such as diabetes and hypertension are essential to establish a right diagnosis and treatment.
在围绝经期过渡期间，轻度高雄激素血症的临床体征可能作为正常衰老过程的一部分出现，但明显的男性化发展提示存在特定的雄激素过多来源。在这种情况下，应排除肾上腺和卵巢水平分泌雄激素的肿瘤。我们报告一例51岁绝经后女性病例，该患者有12个月男性化体征，伴有2型糖尿病和动脉高血压个人史，过去一年病情控制不佳。实验室检查显示血清雄激素水平升高和高胰岛素血症。进行影像学检查，结果显示双侧卵巢增大、均匀且实性，肾上腺未见异常，这导致怀疑可能存在卵巢间质卵泡膜细胞增生。遂行腹腔镜双侧附件切除术，病理报告证实了初步诊断。术后1个月，血清睾酮水平恢复到接近绝经后女性预期的值。在绝经后女性中找到男性化的根源具有挑战性，且通常与罕见病症相关。详细的病史对于区分以良性病因特征的男性化渐进发展与以恶性肿瘤特征的快速进展至关重要。对实验室检查结果结合补充影像学进行充分解读，以及寻找导致心血管风险升高的病症如糖尿病和高血压之间的关联，对于确立正确的诊断和治疗至关重要。
