Department of Clinical Chemistry and Haematology, Meander Medical Centre, Amersfoort, The Netherlands
Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands.
BMJ Case Rep. 2022 Jul 15;15(7):e249651. doi: 10.1136/bcr-2022-249651.
A postmenopausal woman in her 60s was referred due to an elevated haemoglobin value found during her annual check-up. On physical examination, characteristic features of hyperandrogenism were observed which were not earlier mentioned. Laboratory investigations revealed polycythaemia accompanied by a normal erythropoietin and a negative analysis for JAK2-V617F mutation. A disproportionally and markedly elevated testosterone in combination with normal levels of adrenal androgens raised the suspicion of an ovarian source. CT scan showed nodular hyperdense lesions in both ovaries. A bilateral oophorectomy was performed and histological evaluation unfolded a Leydig cell ovarian tumour. Testosterone levels and haematological parameters normalised after surgery. Polycythaemia secondary to hyperandrogenism in postmenopausal women is an extremely rare condition and patients should be carefully analysed for the presence of androgen-secreting neoplasms. Diagnosis of the underlying pathology requires careful history, physical examination and comprehensive investigation. Treatment for this condition is surgery and resolves polycythaemia.
一位 60 多岁的绝经后女性因年度体检发现血红蛋白值升高而被转介。体格检查观察到了高雄激素血症的特征性表现，而这些表现之前并未提及。实验室检查显示红细胞增多症伴正常的促红细胞生成素和 JAK2-V617F 突变阴性分析。睾酮不成比例地显著升高，同时肾上腺雄激素水平正常，这增加了卵巢来源的怀疑。CT 扫描显示双侧卵巢结节状高密度病变。行双侧卵巢切除术，组织学评估显示为睾丸间质细胞瘤。手术后，睾酮水平和血液学参数恢复正常。绝经后女性因高雄激素血症引起的红细胞增多症是一种极其罕见的情况，应仔细分析是否存在雄激素分泌性肿瘤。明确潜在病理需要仔细的病史、体格检查和全面的检查。这种情况下的治疗方法是手术，可解决红细胞增多症。
