Endocrine Abstracts

JOINT3699

Introduction: Several endocrine disorders can lead to elevated testosterone levels in women. During the differential diagnosis, it is essential to consider conditions such as polycystic ovarian syndrome(PCOS), congenital adrenal hyperplasia(CAH), Cushing’s syndrome, exogenous testosterone intake, or testosterone-producing tumours of the ovaries or adrenal glands. In addition to hormonal assessments, imaging methods can be useful for accurate diagnosis.

Case descriptions: A 29-year-old woman was diagnosed with non-classical 21-hidroxylase deficiency. Even with glucocorticoid supplementation, consistently elevated testosterone suggested the possibility of autonomous androgen production. CT of the adrenal glands revealed no abnormalities. Transvaginal ultrasound and pelvic MRI detected a 3 cm mixed-echogenic tumour in the left ovary. A left-sided adnexectomy was performed, and histological analysis confirmed Leydig-cell tumour. A 65-year-old woman was presented with hirsutism. Her testosterone were elevated, whith suppressed LH and FSH. A CT did not reveal any abnormalities in the adrenal gland, the pelvic MRI showed cysts in the right ovary, the left ovary could not be visualized. Exploratory laparoscopy was conducted, leading to a bilateral adnexectomy. The histopathology identified Leydig-cell tumour in the right ovary. A 50-year-old woman was examined because of virilism. Testosterone level was found to be 524ng/dl(ref:8-60ng/dl). Based on hormone levels Cushing-syndrome, PCOS and CAH was unlikely. CT of the adrenal glands suggested the possible presence of right-sided adenoma. Pelvic MRI and transvaginal ultrasound did not indicate tumour in the ovaries. To determine the source of the elevated testosterone, selective sampling of both the ovarian and adrenal veins was performed. The results revealed that the testosterone was produced by the right ovary. Consequently, an adnexectomy was performed, which identified Leydig-cell tumour in the right ovary. A 50-year-old woman presented with hirsutism and androgenic alopecia was diagnosed with hyperandrogenism. An abdominal ultrasound and CT did not describe any abnormalities. However, a transvaginal ultrasound failed to visualize the left ovary. On MRI, a heterogenous, contrast-enhancing tumour measuring 6.3x4.8x6.1 cm in the right ovary was seen. Subsequently, a bilateral adnexectomy was performed. Histology report identified the tumour as Sertoli-cell tumour.

Discussion: Determining the etiology of hyperandrogenism can be challenging. Collaboration with the radiologists and gynaecologists is essential to evaluate each case. The hormonal testing plays a crucial role in the differential diagnosis. However if there is a suspicion of a testosterone-producing tumour, abdominal and pelvic CT and MRI imaging, can provide valuable insights. Selective sampling of the adrenal and ovarian veins may also be helpful in such cases.