Hirsutism affects 510% of women of reproductive age and may be the initial sign of an androgen disorder. We describe two cases of occult Sertoli-Leydig ovarian cell tumor suspected only on the basis of clinical and laboratory features.
The first patient, a 42 year-old woman came to our attention for hirsutism. Several blood samples showed a very high testosterone concentration (~4 ng/ml), while non-ovarian causes of hyperandrogenism were excluded. Abdominal CT scan and transvaginal US showed a bilateral ovarian hyperthecosis, confirmed by diagnostic laparoscopy with bilateral ovarian biopsy. However, signs of hyperandrogenism and testosterone levels were suggestive of a possible occult ovarian cancer. Therefore, the patient underwent bilateral ovariectomy, with histological diagnosis of a right 1.8 cm Sertoli-Leydig cell tumor. After surgery, laboratory data showed a drop in serum testosterone (<0.1 ng/ml). The patient is now on HRT with careful biochemical and clinical observation.
The second patient, a 54 year-old woman, was recently referred to us because of very high testosterone values (~10 ng/ml). An adrenal hyperandrogenism was excluded while abdominal CT scan showed only an uterine fibromatosis, without ovarian malignant features. In spite of this radiological finding, the patient underwent hysterectomy and bilateral ovariectomy, with histological diagnosis of a left 1.7 cm Sertoly-Leydig cell tumor. After surgery, there was a drop in serum testosterone levels. The patient is now in follow-up.
Sertoli-Leydig cell tumor represents less than 0.5% of ovarian tumors: the presence of testicular structures producing androgens can cause virilization. Surgical treatment is recommended for all patients, except in cases of metastatic disease.
We described two cases of severe hyperandrogenism caused by an androgen secreting tumor diagnosed only after bilateral ovariectomy. In fact, despite negative morphological data, in presence of severe clinical features and very high serum testosterone concentration, an occult malignancy should be suspected.
25 - 29 Apr 2009
European Society of Endocrinology