We present a 23 years old woman presenting in the 22nd week of pregnancy with 3 months history of facial hirsutism and progressive deepening of her voice. There had been an episode of vaginal bleeding during the 8th week of pregnancy. Prior to pregnancy the patient had been well and had had no symptoms suggestive of hyperandrogenism. On examination she had facial hirsutism. Her voice was deep. Florid abdominal striae were noted. Examination was otherwise unremarkable.
Investigations revealed a serum testosterone 5313 (NR 2682) ng/dl. Random cortisol was high at cortisol 401.37 (NR 60285 morning, 40150 evening) ng/ml. Serum ACTH was normal at 3.1 pmol/l. Twenty four hour urine free cortisol was normal at 111 nmol/24 hr. Renal and thyroid function tests were also normal. Adominal/pelvic ultrasound study showed a gravid uterus with normal appearing female fetus. Abdominal organs including adrenals appeared to be normal. However a well defined solid appearing lesion in the right ovary, measuring 40x 46.3 mm was noted. Left ovary was normal.
While awaiting results of her endocrine investigations, the patient was seen in another centre and had a laparascopic removal of the right ovarian mass. Histological examination showed an unencapsulated lesion composed of polyhedral cells with abundant clear to granular cytoplasm, round and regular nuclei with rare mitoses. The features were consistent with an ovarian luteoma or a non-hilar Leydig cell tumour.
Unfortunately, the patient had a spontaneous abortion the following day. The fetus looked morphologically normal. The patients testosterone was in the normal range three weeks later. Ovarian luteoma and Leydig cell tumours are rare. Presentation during pregnancy poses unique challenges. A thorough multidisciplinary approach is essential to achieve a satisfactory outcome.
06 - 07 Nov 2006
Society for Endocrinology