ANDROGEN PRODUCING TUMOUR

UTILISING OVARIAN AND ADRENAL VENOUS SAMPLING

Authors

  • Nur Aini Ew Hospital Putrajaya, Malaysia
  • Goh Kg Hospital Putrajaya, Malaysia
  • Azraai B N Hospital Putrajaya, Malaysia

DOI:

https://doi.org/10.15605/jafes.036.S45

Keywords:

venous, androgen

Abstract

INTRODUCTION
Androgen-secreting tumour (AST) is rare, with a prevalence of 0.2% among women with hirsutism. Ovarian and adrenal venous sampling (OAVS) is useful in localising the tumour but has low success rate. We reported a case of ovarian AST with successful cannulation of all 4 veins.
RESULTS
A 26-year-old woman presented with secondary amenorrhoea, hirsutism and voice deepening for 5 years. She did not have Cushing syndrome, or manifestations related to hyperprolactinemia or congenital adrenal hyperplasia. Her family history was unremarkable. On examination, blood pressure was 112/75 mmHg, heart rate 82/min, weight 73 kg, and BMI 25.8 kg/m2 . She has a feminine body habitus with Ferriman-Gallwey score of 17. She has no clitoromegaly. Serum testosterone was 14x the upper limit of normal at 28.87 nmol/L. The following serum hormonal tests were all within normal: TSH 1.194 mU/L, fT4 12.0 pmol/L (7-14.4), prolactin 310 µU/mL, LH 5.8 mU/mL, FSH 6.8 mU/mL, oestradiol 247 pmol/L, Dehydroepiandrostenedione-sulphate (DHEAS) 5.9 µmol/L. Free androgen index was 48 (4x ULN for female). AST of the ovary was suspected. MRI of the adrenal glands and pelvis revealed a heterogeneous enhancement of the left ovary, slightly larger than the right, and normal adrenal glands. All 4 veins were successfully cannulated during OAVS. The increased testosterone secretion was lateralised to the left ovary, consistent with the MRI, with lateralization ratio of 7.9 and 4.4. DISCUSSION A very high testosterone level should raise suspicion of AST. Testosterone >3 nmol/L has a sensitivity of 100% and specificity of 53% in detecting AST. Some reported values >5.2 nmol/L with convincing history. DHEAS level of >18.9 mmol/L strongly suggests adrenal origin. OAVS is useful in cases of small ovarian AST that could not be excluded from biochemical and imaging studies. However, it is a difficult and highly demanding procedure. A centralto-peripheral oestradiol ratio of >2 confirms successful ovarian vein catheterisation. An ovarian vein testosterone gradient of >1.44 confirms lateralization (1).

CONCLUSION
A very high serum testosterone should raise suspicion of AST. OAVS, although difficult, is useful in localising the tumour.

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Author Biographies

Nur Aini Ew, Hospital Putrajaya, Malaysia

Department on Medicine

 
Endocrine Unit, Department of Internal Medicine 

Faculty ofMedicine, Universiti Teknologi MARA (UiTM), Malaysia

Goh Kg, Hospital Putrajaya, Malaysia

Department on Medicine

Azraai B N, Hospital Putrajaya, Malaysia

Department on Medicine

References

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Published

2021-07-28

How to Cite

Ew, N. A. ., Kg, G. ., & N, A. B. . (2021). ANDROGEN PRODUCING TUMOUR: UTILISING OVARIAN AND ADRENAL VENOUS SAMPLING. Journal of the ASEAN Federation of Endocrine Societies, 36, 36. https://doi.org/10.15605/jafes.036.S45

Issue

Section

Abstracts for Poster Presentation | Adult

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