Investigation of patients with atypical or severe hyperandrogenaemia including androgen-secreting ovarian teratoma.
AffiliationDepartment of Endocrinology and Diabetes Mellitus, St Vincent's University, Hospital, Elm Park, Dublin 4, Ireland.
Severity of Illness Index
MetadataShow full item record
CitationEur J Endocrinol. 2010 Feb;162(2):213-20. Epub 2009 Nov 11.
JournalEuropean journal of endocrinology / European Federation of Endocrine Societies
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.
- Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women?
- Authors: Kaltsas GA, Mukherjee JJ, Kola B, Isidori AM, Hanson JA, Dacie JE, Reznek R, Monson JP, Grossman AB
- Issue date: 2003 Jul
- Differential diagnosis of hyperandrogenism in women with polycystic ovary syndrome.
- Authors: Rachoń D
- Issue date: 2012 Apr
- AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ANDROGEN EXCESS AND PCOS SOCIETY DISEASE STATE CLINICAL REVIEW: GUIDE TO THE BEST PRACTICES IN THE EVALUATION AND TREATMENT OF POLYCYSTIC OVARY SYNDROME--PART 1.
- Authors: Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E, American Association of Clinical Endocrinologists (AACE)., American College of Endocrinology (ACE)., Androgen Excess and PCOS Society (AES).
- Issue date: 2015 Nov
- [Sertoli-Leydig cell tumour (arrhenoblastoma) in a patient with polycystic ovary syndrome: clinical, ultrasonographic, hormonal and histopathological evaluation].
- Authors: Puzigaća S, Prelević G, Svetenović Z, Djuricić S, Kokan Dj, Radivojević U
- Issue date: 2001 May-Jun
- Total testosterone and DHEAS levels as predictors of androgen-secreting neoplasms: a populational study.
- Authors: Waggoner W, Boots LR, Azziz R
- Issue date: 1999 Dec