scholarly journals Sex cord stromal tumor of ovary masquerading as polycystic ovarian syndrome

2020 ◽  
Vol 9 (6) ◽  
pp. 2616
Author(s):  
Manisha Jhirwal ◽  
Shashank Shekhar ◽  
Charu Sharma ◽  
Apoorva Tak
Keyword(s):  
Polycystic Ovarian Syndrome ◽  
Serum Testosterone ◽  
Leydig Cell Tumor ◽  
Cell Tumor ◽  
Moderate Elevation ◽  
High Testosterone Level ◽  
Ovarian Syndrome ◽  
Sex Cord Stromal Tumor ◽  
Rule Out ◽  
New Onset

Virilization is a portentous sign that suggests the possibility of an ovarian or adrenal neoplasm. Diagnosis may be delayed in some patients due to nonspecific symptoms and overlapping symptoms with that of polycystic ovarian syndrome (PCOS). However, it must be remembered that PCOS usually causes mild to moderate elevation of serum testosterone with hirsutism whereas serum testosterone levels are many times elevated in cases of androgen secreting tumors and virilization is a norm. So high testosterone level with new onset virilization rule out PCOS. Authors are reporting two cases of Sertoli Leydig cell tumor despite their similar histopathology and equivalent levels of serum testosterone had a varied clinical spectrum of virilization.

scholarly journals Sertoli Leydig Cell Tumour Initially Misdiagnosed as Polycystic Ovarian Syndrome and Congenital Adrenal Hyperplasia: A Case Report

2020 ◽  
Vol 58 (231) ◽  
Author(s):  
Pooja Paudyal ◽  
Geeta Gurung ◽  
Josie Baral ◽  
Nisha Kharel
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Leydig Cell ◽  
Polycystic Ovarian Syndrome ◽  
Serum Testosterone ◽  
Leydig Cell Tumor ◽  
Cell Tumor ◽  
Adrenal Hyperplasia ◽  
Testosterone Levels ◽  
Fertility Sparing ◽  
Ovarian Syndrome

Sertoli-Leydig cell tumor of the ovary is an unusual neoplasm that belongs to a group of sex cord-stromal tumors of the ovary and accounts for less than 0.5% of all primary ovarian neoplasms. They are often characterized by the presence of mass with androgen production and signs of virilization. Due to the substantially low incidence of Sertoli-Leydig cell tumors, information on clinical behavior, prognostic factors, and optimal management arelimited. Here in, we report a case of aprimary ovarian Sertoli-Leydig cell tumor in a 21-year-old student, previously diagnosed to have polycystic ovarian syndrome and subsequently congenital adrenal hyperplasia, who presented with a large abdominal mass and features of virilization along with elevated serum testosterone levels. Fertility sparing unilateral salpingo-oophorectomy was done and adjuvant chemotherapy was given after histopathology showed moderate to poorly differentiated Sertoli-Leydig cell tumor. Following surgery, her features of hyperandrogenism resolved and serum testosterone levels returned to normal.

scholarly journals Role of insulin sensitising agents in altering PSA level in PCOS

2017 ◽  
Vol 6 (11) ◽  
pp. 4986 ◽  
Author(s):  
Rajashree Panigrahy ◽  
Bratati Singh ◽  
Tapan K. Pattnaik ◽  
Sanjukta Misra
Keyword(s):  
Insulin Resistance ◽  
Polycystic Ovarian Syndrome ◽  
Specific Antigen ◽  
Serum Testosterone ◽  
Healthy Controls ◽  
Androgen Excess ◽  
Control Serum ◽  
Ovarian Syndrome ◽  
Significant Concentration

Background: Ovarian androgen production can be promoted by insulin resistance which leads to reproductive abnormalities in Polycystic Ovarian Syndrome (PCOS). A wide variety of female tissues can synthesize and secrete Prostate Specific Antigen (PSA). Androgens may take part a significant role in PSA secretion in PCOS. As insulin resistance stimulates androgen production, the baseline value of PSA may decline by insulin sensitising agents in PCOS. Present study is an attempt to measure the function of PSA as a marker of androgen excess in PCOS and to assess the role of insulin sensitising agent metformin in altering PSA level in PCOS.Methods: The study was undertaken to assess the insulin resistance, testosterone and PSA level in 45 women diagnosed as PCOS and 45 healthy controls. Alteration of insulin resistance, serum testosterone and PSA levels by metformin was also analysed.Results: A significant increase in testosterone, PSA level and insulin resistance was observed in PCOS cases when compared with control (p<0.001). When metformin was given for 4 months, improvement in insulin resistance and testosterone level was found in cases, but PSA values observed no change. Correlation was not found linking insulin resistance with PSA level prior to and after therapy.Conclusions: Serum PSA level could be detected in high significant concentration in PCOS women. Various researches explain that insulin resistance and BMI may perhaps control serum PSA level, but our result demonstrate no effect of insulin sensitising agent on serum PSA value.

scholarly journals Abnormal Elevation of Anti-Mullerian Hormone and Androgen Levels Presenting as Granulosa Cell Tumor

2021 ◽  
Vol 11 ◽  
Author(s):  
Hongbin Chi ◽  
Ning Huang ◽  
Huamao Liang ◽  
Rong Li ◽  
Congrong Liu ◽  
...  
Keyword(s):  
Granulosa Cell ◽  
Polycystic Ovarian Syndrome ◽  
Histopathological Examination ◽  
Granulosa Cell Tumor ◽  
Cell Tumor ◽  
Embryo Cryopreservation ◽  
Granulosa Cell Tumors ◽  
Healthy Female ◽  
Irregular Menses ◽  
Ovarian Syndrome

We report a rare subtype of adult cystic granulosa cell tumor (AGCT) characterized by elevated anti-Mullerian hormone and hyperandrogenism. A 35-year-old woman with primary infertility, hyperandrogenism, and irregular menses who was previously diagnosed with polycystic ovarian syndrome was diagnosed with AGCT based on histopathological examination and FOXL2 genetic test after laparoscopy. Due to fertility aspirations, she underwent controlled ovarian stimulation followed by embryo cryopreservation before salpingo-oophorectomy, and two embryos were frozen-thawed and transferred after surgery. A healthy female infant was delivered at 40 weeks’ gestation. Cystic granulosa cell tumors should be considered a differential diagnosis in patients with persistent ovarian cysts and hyperandrogenism. Younger patients with AGCT with fertility goals should consider active assisted reproduction measures to preserve fertility before treatment for AGCT.

scholarly journals Correlation of serum androgen and gonadotropin with anti-mullerian hormone in polycystic ovarian syndrome in Eastern Indian population

2019 ◽  
Vol 8 (1) ◽  
pp. 256
Author(s):  
Somnath Singh Raghuvanshi ◽  
Anirban Sinha ◽  
Animesh Maiti ◽  
Partha Pratim Chakraborty ◽  
Asish Kumar Basu ◽  
...  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Polycystic Ovarian Syndrome ◽  
Pulse Generator ◽  
Polycystic Ovary ◽  
Serum Testosterone ◽  
Pulse Frequency ◽  
Strong Positive Correlation ◽  
Ovary Syndrome ◽  
Cross Sectional ◽  
Ovarian Syndrome

Background: Ovarian steroidogenesis requires gonadotropin stimulation, Luteinizing Hormone (LH) is a key factor in the hyperandrogenaemia of the polycystic ovary syndrome. Progesterone is the primary regulator of Gonadotropin-Releasing Hormone (GnRH) pulse frequency; however, in the polycystic ovary syndrome, the GnRH pulse generator is relatively resistant to the negative feedback effects of progesterone.  Study aims to evaluate the association of Anti-mullerian hormone with serum androgen and gonadotropin level in adolescents and young women of Polycystic Ovary Syndrome (PCOS).Methods: This was a single centre observational Cross-sectional study carried out in the department of Endocrinology and metabolism, Medical College, Kolkata from March 2017 to January 2019. Total number of study subjects were 207 out of which 138 were cases.Results: The AMH had strong positive correlation with serum testosterone in both case and control groups (r 0.542, p<0.001 and r 0.57, p<0.001) respectively .After the adjustment of age and BMI , the AMH moderately positive  but extremely significant correlation with serum testosterone as compare to control.Conclusions: Hyperandrogenaemia and higher ratio of LH and FSH associated with higher serum AMH level is associated with the higher serum AMH in polycystic ovarian syndrome.

scholarly journals Association of altered thyroid function and prolactin level in polycystic ovarian syndrome

2016 ◽  
Vol 45 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Marufa Mustari ◽  
MA Hasanat ◽  
Qamrul Hasan ◽  
Sadiqa Tuqan ◽  
Md Shah Emran ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Prolactin Level ◽  
Polycystic Ovarian Syndrome ◽  
Density Lipoprotein ◽  
Serum Testosterone ◽  
Thyroid Stimulating Hormone ◽  
Primary Infertility ◽  
Altered Thyroid ◽  
Ovarian Syndrome ◽  
Stimulating Hormone

Polycystic ovarian syndrome (PCOS) is a common disorder for female with fertile age. Along with other clinical and biochemical manifestations, thyroid function and prolactin level may be altered in patients with PCOS. This study aimed to evaluate the clinical and biochemical status, as well as alteration of thyroid stimulating hormone (TSH), prolactin (PRL) level in patients with PCOS. Present study comprised of 100 diagnosed PCOS patients according to revised Rotterdem Consensus criteria. All patients were studied for serum testosterone, LH (lutenizing hormone), FSH (follicle stimulating hormone), blood glucose, lipid profile as well as TSH, FT4 (free thyroxin) and prolactin level. Out of 100 PCOS patients 97 had hirsutism, 64 had acanthosis nigricans, where menstrual irregularities were in 94 patients. Diastolic blood pressure (74±1.1 vs. 77±0.9, mmHg; p=0.017), total cholesterol (163±5.3 vs. 193±6.2 mg/dl; p<0.001), low density lipoprotein (LDL, 104±3.7 vs. 124±4.9 mg/dl; p=0.002) and frequency of acanthosis (25% vs. 75%; p<0.001) were significantly higher among the patients having BMI>25 Kg/m2 than those of have ? 25 Kg/m2. Among the fertile women (n=53), 47% had primary and 41.5% had secondary infertility; whereas of the total patients, 21% had altered thyroid function and 6.1% had raised prolactin (PRL, ng/ml) level. Differences of TSH (4.1±3.6 vs. 3.5±6.8, mIU/L; p=0.725) was not significant; whereas level of PRL (13.87±6.9vs. 9.4±5.2 ng/ml; p=0.018) was significantly higher in the group of primary infertility. Hirsutism, menstrual disturbance and acanthosis were very common in PCOS. Both primary and secondary sterility were also commonly observed and PRL was higher in primary infertility. About one fifth of PCOS had altered thyroid function.Bangladesh Med J. 2016 Jan; 45 (1): 1-5

scholarly journals Virilising ovarian tumors: a single-center experience

2018 ◽  
Vol 7 (12) ◽  
pp. 1362-1369
Author(s):  
Manjeetkaur Sehemby ◽  
Prachi Bansal ◽  
Vijaya Sarathi ◽  
Ashwini Kolhe ◽  
Kanchan Kothari ◽  
...  
Keyword(s):  
Leydig Cell ◽  
Serum Testosterone ◽  
Leydig Cell Tumor ◽  
Cell Tumor ◽  
Ovarian Tumors ◽  
Reproductive Age ◽  
Primary Amenorrhea ◽  
Total Testosterone ◽  
Western India ◽  
Duration Of Symptoms

Literature on virilising ovarian tumors (VOTs) is limited to case reports and series reporting single pathological type. We have analyzed the clinical, hormonal, radiological, histological, management and outcome data of VOT. This retrospective study was conducted at a tertiary health care center from Western India. Consecutive patients with VOT presenting to our endocrine center between 2002 and 2017 were included. Our study included 13 patients of VOT. Out of 13 patients, two were postmenopausal. All patients in the reproductive age group had secondary amenorrhea except one who presented with primary amenorrhea. Modified F and G score (mFG) at presentation was 24 ± 4.3 and all patients had severe hirsutism (mFG ≥15). Change in voice (n = 11) and clitoromegaly (n = 7) were the other most common virilising symptoms. Duration of symptoms varied from 4 to 48 months. Median serum total testosterone level at presentation was 5.6 ng/mL with severe hyperandrogenemia (serum testosterone ≥2 ng/mL) but unsuppressed gonadotropins in all patients. Transabdominal ultrasonography (TAS) detected VOT in all except one. Ten patients underwent unilateral salpingo-oophorectomy whereas three patients (peri- or postmenopausal) underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Seven patients had Sertoli Leydig cell tumor, three had steroid cell tumor and two had Leydig cell tumor and one had miscellaneous sex cord stromal tumor. All patients had normalization of serum testosterone after tumor excision. In conclusion, VOTs present with severe hyperandrogenism and hyperandrogenemia. Sertoli Leydig cell tumor is the most common histological subtype. Surgery is the treatment of choice with good surgical outcome.

scholarly journals An adolescent girl with coexisting ovarian mature cystic teratoma and HAIR-AN syndrome, an extreme subtype of polycystic ovarian syndrome

2021 ◽  
Vol 2021 ◽  
Author(s):  
Jin Hui Ho ◽  
Ana Vetriana Abd Wahab ◽  
Yin Khet Fung ◽  
Serena Sert Kim Khoo
Keyword(s):  
Insulin Resistance ◽  
Testosterone Level ◽  
Acanthosis Nigricans ◽  
Polycystic Ovarian Syndrome ◽  
Reference Range ◽  
Cystic Teratoma ◽  
Serum Testosterone ◽  
Total Serum ◽  
Upper Limit ◽  
Ovarian Syndrome

Summary Polycystic ovarian syndrome (PCOS) is associated with menstrual irregularities, ovulatory dysfunction, hirsutism, insulin resistance, obesity and metabolic syndrome but is rarely associated with severe hyperandrogenaemia and virilisation resulting in male pattern baldness and clitoromegaly. Total serum testosterone greater than twice the upper limit of the reference range or free androgen index of over five-fold elevated suggests a diagnosis other than PCOS. We reported a case of a 15 years old obese girl presented with secondary amenorrhoea, virilising signs: frontal baldness, clitoromegaly and prominent signs of insulin resistance and marked acanthosis nigricans. Her total testosterone level was markedly elevated at 9.4 nmol/L (0.5–1.7 nmol/L) and MRI pelvis revealed a right ovarian mass with fat and cystic component and a left polycystic ovary. The patient underwent laparoscopic right ovarian cystectomy and histologically confirmed mature cystic teratoma. Post-operatively, her testosterone level declined but did not normalise, menses resumed but remained irregular. Her fasting insulin was elevated 85.2 mIU/L (3–25 mIU/L) and HOMA-IR was high at 13.1 (>2) with persistent acanthosis nigricans suggesting co-existing HAIR-AN syndrome, an extreme phenotype of polycystic ovarian syndrome. Learning points Rapid onset of hyperandrogenic symptoms, especially if associated with signs of virilisation must raise the suspicion of an androgen-secreting tumour. Total serum testosterone greater than twofold the upper limit of the reference range or free androgen indices over fivefold suggest a diagnosis other than polycystic ovarian syndrome (PCOS). High levels of testosterone with normal levels of the DHEA-S suggest an ovarian source. Ovarian androgen-secreting tumour and HAIR-AN syndrome, an extreme spectrum of PCOS can co-exist.

scholarly journals Management Infertility by Hormones Replacement Therapy in Women with Polycystic Ovarian Syndrome

2020 ◽  
Vol 10 (1) ◽  
pp. 170-174
Author(s):  
Sardar Q. Umer ◽  
Tariq W. Sadeq
Keyword(s):  
Low Dose ◽  
Polycystic Ovarian Syndrome ◽  
Polycystic Ovary ◽  
Follicle Stimulating Hormone ◽  
Serum Testosterone ◽  
Recombinant Fsh ◽  
Short And Long Term ◽  
Ovarian Syndrome ◽  
Stimulating Hormone

Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder characterized by multiple hormonal imbalances; the clinical presentation dominated by manifestations of hyperandrogenism, which generates short- and long-term consequences on female health sterility, infertility is one of the most alarming associated morbidities. Forty women (28.9 ± 0.8 years old) with polycystic ovarian syndrome had infertility and there were enrolled in these clinical trials and randomly allocated into two groups. Group one and Group two were given treated infertility drugs (Clomid 5 mg for 5 days) and recombinant follicle-stimulating hormone (rFSH) 75 IU for long and short duration to get pregnant. Serum testosterone, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) of both groups were measured when women diagnosed as PCOS. The results showed that women which treated by low-dose recombinant FSH 75 IU for 3 days consequently (Group one) have significant decreased LH, while progesterone and FSH significantly increased after treated by hormone therapy P ≥ 0.05 while after treatment with recombinant FSH IU for 5 days (Group two), the result showed non-significant effect as compared with the first group. Concluded: Increase pregnant rate and decrease over stimulation syndrome among infertile women associated with polycystic overian syndrome, when treated with applicated low dose and short term by rFSH hormone.

scholarly journals Marked hyperandrogenicity in a 60-year-old woman

2017 ◽  
Vol 2017 ◽  
Author(s):  
Khaled Aljenaee ◽  
Sulaiman Ali ◽  
Seong Keat Cheah ◽  
Owen MacEneaney ◽  
Niall Mulligan ◽  
...  
Keyword(s):  
Leydig Cell ◽  
Testosterone Level ◽  
Histopathological Examination ◽  
Incidental Finding ◽  
Serum Testosterone ◽  
Leydig Cell Tumor ◽  
Cell Tumor ◽  
Serum Testosterone Level ◽  
List Type ◽  
Dheas Level

Markedly elevated androgen levels can lead to clinical virilization in females. Clinical features of virilization in a female patient, in association with biochemical hyperandrogenism, should prompt a search for an androgen-producing tumor, especially of ovarian or adrenal origin. We herein report the case of a 60-year-old woman of Pakistani origin who presented with the incidental finding of male pattern baldness and hirsutism. Her serum testosterone level was markedly elevated at 21 nmol/L (normal range: 0.4–1.7 nmol/L), while her DHEAS level was normal, indicating a likely ovarian source of her elevated testosterone. Subsequently, a CT abdomen-pelvis was performed, which revealed a bulky right ovary, confirmed on MRI of the pelvis as an enlarged right ovary, measuring 2.9 × 2.2 cm transaxially. A laparoscopic bilateral salpingo-oophorectomy was performed, and histopathological examination and immunohistochemistry confirmed the diagnosis of a Leydig cell tumor, a rare tumor accounting for 0.1% of ovarian tumors. Surgical resection led to normalization of testosterone levels. Learning points: Hirsutism in postmenopausal women should trigger suspicion of androgen-secreting tumor Extremely elevated testosterone level plus normal DHEAS level point toward ovarian source Leydig cell tumor is extremely rare cause of hyperandrogenicity

scholarly journals Ovarian Leydig cell tumor in a post-menopausal patient with severe hyperandrogenism

2014 ◽  
Vol 58 (1) ◽  
pp. 68-75 ◽  
Author(s):  
Selma B. Souto ◽  
Pedro V. Baptista ◽  
Daniel C. Braga ◽  
Davide Carvalho
Keyword(s):  
Leydig Cell ◽  
Transvaginal Ultrasound ◽  
Serum Testosterone ◽  
Leydig Cell Tumor ◽  
Cell Tumor ◽  
Menopausal Woman ◽  
Axial Tomography ◽  
Computerized Axial Tomography ◽  
Low Levels ◽  
Post Menopausal

Leydig cell tumors are rare ovarian steroid cell neoplasms. More than 75% of patients show signs of virilization due to overproduction of testosterone. We report a case of an 8-year-old woman with progressive signs of virilization, and presenting vaginal bleeding. Clinical analyses revealed high levels of serum testosterone, delta 4-androstenedione and estradiol, and also inappropriate low levels of gonadotrophins for a post-menopausal woman. Transvaginal ultrasound showed no evidence of ovarian tumor, but pelvic and abdominal computerized axial tomography imaging revealed a left ovarian solid nodule, and no evidence of alteration in the adrenal glands. Total hysterectomy and bilateral salpingoophorectomy were performed. Histopathology and immunohistochemistry confirmed the diagnosis of Leydig cell tumor. After surgery, androgen levels returned to normal, and there was regression of the signs of virilization.

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