Androgen secreting ovarian tumours account for 0.1% of ovarian tumours. They can appear at any age (mean, 42 years) and can be slow growing.
We report a case of androgen secreting ovarian tumour diagnosed at a delayed stage. It is unusual as it evaded diagnosis because of various factors, which we believe should be learning lesions.
A 56-year-old lady with medical history of sub-arachnoid haemorrhage (SAH), presented with features of gradual onset abdominal discomfort. GP was concerned of malignancy.
On examination, she was found to be strikingly virilised. Her endocrine assessment showed testosterone above 52 nmol/l (0.22.9), androstenedione >35 nmol/l (410.2) with DHEAS at 0.9 μmol/l (0.44.7) with <0.1 μmol/l of FSH/LH. She had raised ovarian tumour marker CA 125>1183 (035 kU/l) raising the possibility of ovarian malignancy. CT abdomen/pelvis confirmed a right ovarian mass with normal appearing adrenals. She subsequently underwent bilateral salpingo-oophorectomy and hysterectomy. Histopathology confirmed the mass as Steroid cell tumour.
She was admitted to secondary care centre 30 years ago for sub-arachnoid haemorrhage. She had recorded features of Cushings and hirsutism during that admission. Her assessment then had shown normal testosterone, FSH/LH, prolactin, thyroid functions with negative screening for Cushings.
She had several generalised seizures during the period of hospital stay for SAH managed with long-term phenytoin. She had started using a wig since 10 years because of male pattern of balding and we could not find any medical consultation for that.
Steroid cell tumours are slow growing and we believe this might be a possible reason for the delay in diagnosis. Also the fact she had assessment for her hirsutism 30 years ago when she was acutely unwell. This emphasises the importance of repeating hormonal assessment when clinical suspicion is high and the unreliability of hormonal investigations, during an acute illness.