ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P310 | DOI: 10.1530/endoabs.63.P310

Diagnosis and management of severe hyperandrogenism in the context of tumoral suspicion: case-series report from a tertiary hospital

Andrés Ortiz-Flores1,2, Manuel Luque-Ramírez1,2, Elena Fernández-Durán1,2, Belén Vega-Piñeiro2 & Héctor Escobar-Morreale1,2

1Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; 2Diabetes, Obesity and Human Reproduction Research Group, Hospital Universitario Ramón y Cajal, Madrid, Spain.

Background: The finding of severe hyperandrogenemia, rapidly progressive clinical hyperandrogenism, defeminization and/or virilization in women of any age should raise the suspicion of an ovarian or adrenal malignancy. Similarly, moderate to severe hyperandrogenemia after menopause, and its clinic consequences, force clinicians to rule out a tumoral source.

Matherial and methods: Observational cross-sectional study conducted in patients derived to our clinic for the assessment of hyperandrogenism, from 1998 to 2018. We retrieved biochemical and radiologic data of those women fulfilling the following criteria: i) women of any age, in whom hyperandrogenic symptoms were severe and/or rapidly progressive, and/or total testosterone concentrations were >200 ng/dl, and ii) post-menopausal women with clinical or biochemical hyperandrogenism. Ovarian ultrasound and abdominal CT were performed in all these women.

Results: The data of 14 women were recorded. All but one were postmenopausal. Mean age was 61±17 years-old. Total and free testosterone concentrations were 159 (107–466) ng/dl and 79 (56–246) pmol/l, respectively. Median time from the onset of clinical hyperandrogenism to the first visit to our clinic was 2 (0.75–5) years. Progressive hirsutism was the first sign of clinical hyperandrogenism in a majority of women [8 (58%)], followed by moderate-to-severe alopecia [6 (43%9]. Clitoromegaly as a sign of virilization was observed in five patients (36%). Ovarian ultrasound showed a solid tumor in four patients, mucinous cyst in one patient and a false positive in another one. One women had both an adrenal and ovarian tumor, while three of them had an adrenal incidentaloma, none of the latter were malign. Simultaneous venous adrenal and gonadal catheterism and sampling was necessary in 3 of these patients for establishing diagnosis. Twelve women underwent surgery, whereas the remaining received medical treatment. Histopathological assessment showed ovarian hyperthecosis in five out of twelve women (42%), whereas a tumoral androgen source was identified in seven patients (58%). From the latter, six women had a sex-cord stromal tumor. None of the patients had an adrenal source of androgen excess in our series.

Conclusion: Tumoral etiology should be ruled out in women with severely high of sex-androgens concentrations, and/or when symptoms are rapidly progressive. Ovarian hyperthecosis is a common cause of hyperandrogenism at menopause, although tumoral diagnosis must be always considered in the differential diagnosis.

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