Investigation of patients with atypical or severe hyperandrogenaemia including androgen-secreting ovarian teratoma.

Hdl Handle:
http://hdl.handle.net/10147/207653
Title:
Investigation of patients with atypical or severe hyperandrogenaemia including androgen-secreting ovarian teratoma.
Authors:
Dennedy, Michael Conall; Smith, Diarmuid; O'Shea, Donal; McKenna, T Joseph
Affiliation:
Department of Endocrinology and Diabetes Mellitus, St Vincent's University, Hospital, Elm Park, Dublin 4, Ireland.
Citation:
Eur J Endocrinol. 2010 Feb;162(2):213-20. Epub 2009 Nov 11.
Journal:
European journal of endocrinology / European Federation of Endocrine Societies
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207653
DOI:
10.1530/EJE-09-0576
PubMed ID:
19906851
Abstract:
Approximately 7% of women of reproductive age manifest polycystic ovary syndrome (PCOS) and <0.5% have other causes of hyperandrogenism including congenital adrenal hyperplasia (CAH), androgen-secreting tumour of an ovary or an adrenal gland, Cushing's syndrome or hyperthecosis. The presence of features atypical of PCOS should prompt more extensive evaluation than that usually undertaken. Features atypical of PCOS include the onset of symptoms outside the decade of 15-25 years, rapid progression of symptoms, the development of virilization and a serum testosterone concentration in excess of twice the upper limit of the reference range. Ethnic background, family history and specific clinical findings, e.g. Cushingoid appearance, may inform a focused investigation. Otherwise, patients should have measurement of 17-hydroxyprogesterone (17-OHP) under basal conditions ideally in the early morning, and if abnormal, they should have measurement of 17-OHP one hour after the administration of synthetic ACTH, 250 microg i.v., to screen for CAH, which is present in approximately 2% of hyperandrogenic patients. The overnight cortisol suppression test employing 1 mg dexamethasone at midnight is a sensitive test for Cushing's syndrome. Coronal tomographic (CT) scanning of the adrenals and transvaginal ultrasonography of the ovaries are the investigations of choice when screening for tumours in these organs. Less frequently required is catheterization and sampling from both adrenal and ovarian veins, which is a technically demanding procedure with potential complications which may provide definitive diagnostic information not available from other investigations. Illustrative case reports highlight some complexities in the investigation of hyperandrogenic patients presenting with features atypical of PCOS and include only the ninth case report of an androgen-secreting ovarian teratoma.
Language:
eng
MeSH:
Androgens/secretion; Female; Humans; Hyperandrogenism/*diagnosis/*etiology; Ovarian Neoplasms/*complications/*diagnosis/secretion; Severity of Illness Index; Teratoma/*complications/*diagnosis/secretion
ISSN:
1479-683X (Electronic); 0804-4643 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorDennedy, Michael Conallen_GB
dc.contributor.authorSmith, Diarmuiden_GB
dc.contributor.authorO'Shea, Donalen_GB
dc.contributor.authorMcKenna, T Josephen_GB
dc.date.accessioned2012-02-01T10:34:03Z-
dc.date.available2012-02-01T10:34:03Z-
dc.date.issued2012-02-01T10:34:03Z-
dc.identifier.citationEur J Endocrinol. 2010 Feb;162(2):213-20. Epub 2009 Nov 11.en_GB
dc.identifier.issn1479-683X (Electronic)en_GB
dc.identifier.issn0804-4643 (Linking)en_GB
dc.identifier.pmid19906851en_GB
dc.identifier.doi10.1530/EJE-09-0576en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207653-
dc.description.abstractApproximately 7% of women of reproductive age manifest polycystic ovary syndrome (PCOS) and <0.5% have other causes of hyperandrogenism including congenital adrenal hyperplasia (CAH), androgen-secreting tumour of an ovary or an adrenal gland, Cushing's syndrome or hyperthecosis. The presence of features atypical of PCOS should prompt more extensive evaluation than that usually undertaken. Features atypical of PCOS include the onset of symptoms outside the decade of 15-25 years, rapid progression of symptoms, the development of virilization and a serum testosterone concentration in excess of twice the upper limit of the reference range. Ethnic background, family history and specific clinical findings, e.g. Cushingoid appearance, may inform a focused investigation. Otherwise, patients should have measurement of 17-hydroxyprogesterone (17-OHP) under basal conditions ideally in the early morning, and if abnormal, they should have measurement of 17-OHP one hour after the administration of synthetic ACTH, 250 microg i.v., to screen for CAH, which is present in approximately 2% of hyperandrogenic patients. The overnight cortisol suppression test employing 1 mg dexamethasone at midnight is a sensitive test for Cushing's syndrome. Coronal tomographic (CT) scanning of the adrenals and transvaginal ultrasonography of the ovaries are the investigations of choice when screening for tumours in these organs. Less frequently required is catheterization and sampling from both adrenal and ovarian veins, which is a technically demanding procedure with potential complications which may provide definitive diagnostic information not available from other investigations. Illustrative case reports highlight some complexities in the investigation of hyperandrogenic patients presenting with features atypical of PCOS and include only the ninth case report of an androgen-secreting ovarian teratoma.en_GB
dc.language.isoengen_GB
dc.subject.meshAndrogens/secretionen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshHyperandrogenism/*diagnosis/*etiologyen_GB
dc.subject.meshOvarian Neoplasms/*complications/*diagnosis/secretionen_GB
dc.subject.meshSeverity of Illness Indexen_GB
dc.subject.meshTeratoma/*complications/*diagnosis/secretionen_GB
dc.titleInvestigation of patients with atypical or severe hyperandrogenaemia including androgen-secreting ovarian teratoma.en_GB
dc.contributor.departmentDepartment of Endocrinology and Diabetes Mellitus, St Vincent's University, Hospital, Elm Park, Dublin 4, Ireland.en_GB
dc.identifier.journalEuropean journal of endocrinology / European Federation of Endocrine Societiesen_GB
dc.description.provinceLeinster-

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