1/23. Managing a patient with presumed testosterone-secreting ovarian tumor.We report the case of a 70-year-old woman who was presumed to have right ovarian testosterone-secreting tumor and was treated with long-acting gonadotropin-releasing hormone agonist therapy plus add-back hormone replacement therapy. The patient presented with various medical problems including hypertension, intracranial hemorrhage, myocardial infarction, unstable angina pectoris, and poor control of diabetic mellitus and had exhibited rapid symptoms of androgen excess such as progressive hirsutism and bilateral temporal balding for half a year. Tumor survey was negative except for an elevated testosterone level. Renal vein catheterization successfully detected a right ovarian androgen-secreting tumor. Because the patient was deemed medically unable to tolerate surgery, she received an alternative treatment consisting of 6 months of gonadotropin-releasing hormone-agonist (GnRH-a) and add-back hormone replacement therapy (HRT). serum testosterone levels returned to normal limits after administration of the first dose of GnRH-a. A follow-up tumor survey was negative. The patient has been alive and free of disease for 8 months after six doses of GnRH-a. We conclude that this strategy might be used as urgent therapy in a medically compromised patient with presumed ovarian androgen-secreting tumor.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
2/23. Cystic pelvic pathology presenting as falsely elevated post-void residual urine measured by portable ultrasound bladder scanning: report of 3 cases and review of the literature.Dedicated portable ultrasound devices generally offer a rapid, noninvasive, largely operator-independent means of assessing post-void residual urine (PVR) volume. In most published series, PVR measured by portable ultrasound correlates well with catheterized urine volume. We report 3 cases in which follow-up of falsely elevated PVR measurements on ultrasound resulted in comparatively low catheterized volumes. In all 3 cases, the elevated readings were due to cystic ovarian pathology, which was diagnosed by formal radiologic evaluation and ultimately confirmed operatively in 2 cases. Cystic pathology of the pelvis or lower abdomen may present as an elevated PVR on ultrasound and low urine volume on subsequent catheterization and should prompt further evaluation.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
3/23. Intraoperative testosterone assay for virilizing ovarian tumor topographic assessment: report of a leydig cell tumor of the ovary in a premenopausal woman with an adrenal incidentaloma.Ovarian virilizing tumors are rare and can lead to assessment difficulties because of their small size. A 41-yr-old female was referred for evaluation of hirsutism that had increased within the previous 3 yr. menstrual cycle length was normal. plasma testosterone was 3.9 ng/ml (normal range, 0.2-0.8 ng/ml), was not suppressible by 2 mg dexamethasone (4.3 ng/ml), and was increased (6.3 ng/ml) after three daily injections of hCG (5000 IU). Abdominal computed tomography scan showed an adrenal nodule (13 x 6 mm) that remained unchanged after 3 months. Ultrasound examination of the pelvis was normal. Ovarian and adrenal venous catheterization did not yield additional information. Topographic assessment was made by intraoperative measurement of testosterone in the samples taken from each ovarian vein (competitive chemiluminescent immunoassay ADVIA Centaur; right ovarian vein, 105 ng/ml; left ovarian vein, 5 ng/ml; peripheral blood, 7 ng/ml). Right annexectomy resulted in normalization of testosterone levels (0.22 ng/ml). Histopathological examination found a leydig cell tumor of hilar type (1.5 cm). This observation illustrates the usefulness of intraoperative measurement of testosterone by a rapid automated technique for topographic assessment of ovarian virilizing tumor in premenopausal women.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
4/23. Combined ovarian vein catheterization with ovarian stimulation in the diagnosis of androgen overproduction.A 28-year-old woman was evaluated for late onset secondary amenorrhea, progressive hirsutism and an elevated serum testosterone concentration. Her serum cortisol, androstenedione, dehydroepiandrosterone sulfate and 17-hydroxyprogesterone levels were normal. Bilateral ovarian and adrenal vein catheterization demonstrated mild elevated testosterone and androstenedione levels in the right ovarian vein. Fifteen minutes after administering the intravenous injection of 5,000 IU human chorionic gonadotropin, there was a six and a half to sevenfold increase in the level of these two hormones in the right ovarian vein with no significant change in hormone levels from other sources. Based on the ovarian peripheral vein gradients obtained during venography following ovarian stimulation, the diagnosis of right ovarian hyperthecosis was made. This diagnosis could not have been reached without the combination of selective ovarian vein catheterization and ovarian stimulation. We recommend that this combined test, which may provide additional information on the source of the androgens in women with hyperandrogens, be performed in selected cases, when a virilizing tumor is suspected.- - - - - - - - - - ranking = 6keywords = catheterization (Clic here for more details about this article) |
5/23. Coincidental diagnosis of an occult hilar steroid cell tumor of the ovary and a cortisol-secreting adrenal adenoma in a 49-year-old woman with severe hyperandrogenism.OBJECTIVE: To report an exceptional association between an occult ovarian steroid cell tumor and a cortisol-secreting adrenal adenoma. DESIGN: Case report. SETTING: endocrinology and nutrition unit at a general hospital in spain. PATIENT(S): A 49-year-old woman who presented with persistence of severe hyperandrogenism after removal of a left adrenal adenoma. INTERVENTION(S): An endocrine study evaluating serum androgens, adrenal function, and tumor markers was ordered. Transvaginal sonography was done to rule out an ovarian tumor. Finally, a selective catheterization of ovarian veins allowed the correct diagnosis. MAIN OUTCOME MEASURE(S): Clinical and endocrine description of the patient and preoperative localization of the source of T secretion. RESULT(S): After adrenal surgery, urinary free cortisol levels decreased to normal values, but serum T remained within the tumoral range (3.04 ng/mL). Selective catheterization of ovarian veins revealed a gradient of T concentration in the right ovary. After bilateral annexectomy, a microscopic steroid cell tumor of hilar type was found in the right ovary. serum T fell within the normal range, and hirsutism progressively improved. CONCLUSION(S): This unusual association between an occult-virilizing ovarian steroid cell tumor and a cortisol-secreting adrenal adenoma illustrates the value of an accurate preoperative workup in women with severe hyperandrogenism.- - - - - - - - - - ranking = 2keywords = catheterization (Clic here for more details about this article) |
6/23. Selective ovarian vein sampling to localize a leydig cell tumor.OBJECTIVE: To describe a patient with recent onset of rapidly progressive virilization who was diagnosed with an androgen-secreting tumor of the left ovary, localized by selective ovarian vein catheterization and hormonal sampling (SOVHS). DESIGN: Case report. SETTING: Tertiary community-based medical center. PATIENT(S): A 32-year-old woman presenting with progressive virilization over a period of 4 months was found to have a leydig cell tumor of the left ovary. INTERVENTION(S): Transvaginal ultrasound of the pelvis, followed by contrast-enhanced computerized tomography of the abdomen and the pelvis. Selective ovarian vein sampling was performed to localize the tumor. Laparoscopic left salpingo-oophorectomy and washings were also performed. MAIN OUTCOME MEASURE(S): Initial serum total T levels were 1,505 ng/dL, and the free serum T levels were 234 ng/dL. After SOVHS, the total serum T levels in the left ovarian vein is reported to be 20,967 ng/dL, and in the right ovarian vein, they were reported to be 1,351 ng/dL. Three months after laparoscopic left oophorectomy, the serum total T levels were 11 ng/dL. Institutional review board approval was obtained. RESULT(S): Patient's ovarian tumor removed laparoscopically was reported to be a leydig cell tumor. Rapid decreases in free and total T followed tumor removal. CONCLUSION(S): Selective ovarian vein catheterization and hormonal sampling is an effective diagnostic modality that can help localize small ovarian tumors.- - - - - - - - - - ranking = 2keywords = catheterization (Clic here for more details about this article) |
7/23. Postmenopausal androgen secreting ovarian tumour: pathophysiological implications; a case report.hyperandrogenism in women is usually accompanied by a disruption of the hypothalamic-pituitary-ovarian axis; however, the precise effect of chronically elevated androgens on this axis is poorly understood. We report a postmenopausal woman with a virilizing ovarian tumour in whom the effects of chronic testosterone secretion on the hypothalamic-pituitary axis was investigated. A 56-year-old woman was evaluated for hirsutism and hyperandrogenism of recent onset. Peripheral serum testosterone was high (19.4 nmol/l), while gonadotropins were below normal for a postmenopausal woman, FSH (19.7 IU/l) being higher than LH (10.3 IU/l). Four LH and 1 FSH pulse were detected over 4 h. A left intraovarian testosterone secreting tumour, shown by catheterization of the ovarian veins and containing imperfect crystalloids of Reinke, was excised. Postoperatively, peripheral testosterone became undetectable, while gonadotropins rose to normal postmenopausal values. This patient's LH/FSH ratio was less than 1, in contrast with other situations of chronic hyperandrogenism. This could be explained by the concomitant hypoestrogenic state, and/or the theoretical absence of inhibin. The interest of this case resides in that it constitutes an appropriate model for studying the effects of testosterone on LH and FSH secretion in the absence of the other two classically involved modulators, namely oestrogens and inhibin.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
8/23. Adrenocorticotropin-dependent virilizing paraovarian tumors in Nelson's syndrome.A 35-yr-old woman with Nelson's syndrome presented with amenorrhea and virilization. serum testosterone (T) concentration was 605 ng/dl and fell to 33 ng/dl when dexamethasone was administered. The MCR of T fell from 1383 to 991 liters/day and the T production rate decreased by 96%. With administration of synthetic ACTH, T concentration rose to 338 ng/dl. plasma ACTH concentration paralleled T during repeated suppression testing, suggesting that T secretion was dependent on ACTH hypersecretion. Preoperative and intraoperative ovarian vein catheterization suggested that the predominant source of androgen production was from the right ovarian vein. Laporatomy revealed multiple paraovarian tumors in the right mesosalpinyx and mesovarium. Incubation of tumor slices and ovarian tissue with [3H]pregnenolone and [14C]17-hydroxyprogesterone demonstrated conversion of both precursors to T by the tumor and confirmed that the tumors were the source of androgen excess. The microscopic appearance of the tumors closely resembled the morphology of testicular and paratesticular tumors of men with congenital adrenal hyperplasia and Nelson's syndrome. The analogous dependency of the tumors on ACTH hypersecretion in men with paratesticular tumors and in this woman with paraovarian tumors suggests that the tumors may arise in both males and females from a common steroid-secreting cell of adrenogenital origin.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
9/23. Production of immunoreactive inhibin by a virilizing ovarian tumour (Sertoli-Leydig tumour).A 59-year-old post-menopausal woman was admitted to the hospital with atypical vaginal bleeding and hirsute lower extremities. There was a high serum testosterone level (15.8 nmol/l) and also an appreciable serum immunoreactive inhibin level. No adrenal or ovarian lesions were detected by conventional imaging procedures. Selective blood sampling was performed during venous catheterization and showed that testosterone and inhibin levels were highest in the right ovarian vein. laparotomy revealed a Sertoli-Leydig tumour in the right ovary, which was excised. Post-operatively, immunoreactive inhibin became undetectable while the testosterone level fell to 2.8 nmol/l. Specific radioimmunoassay showed a high immunoreactive inhibin content in the tumour. These findings indicate that Sertoli-Leydig tumours can produce both testosterone and immunoreactive inhibin, both of which would then inhibit LH and FSH release to produce the symptoms seen in this patient. Thus, assay of inhibin may aid in the differential diagnosis of virilizing tumours.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
10/23. Steroid secretion by a virilizing lipoid cell ovarian tumor: origins of dehydroepiandrosterone sulfate.A 78-year-old woman had a 3-year history of severe virilization caused by a lipoid cell ovarian tumor localized by pelvic ultrasound examination and NP-59 scan. Steroid secretion was evaluated by the following: 1) peripheral plasma levels before and after hormonal stimulation with ACTH or hCG, 2) venous catheterization and measurement of steroid levels in the left and right ovarian veins during surgery, 3) measurements of enzymatic activities in the tumor tissue compared with those in normal ovarian tissue, and 4) steroid secretion studies in vitro of the tumor tissue, surrounding tissue, and contralateral ovarian tissue. The tumor tissue secreted both delta 5 and delta 4 androgens, including dehydroepiandrosterone sulfate. dehydroepiandrosterone sulfate was also secreted by the surrounding and contralateral ovarian tissue.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
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