Hormonally active gynecologic tumors

Abstract

Hormonally active gynecologic tumors include gestational trophoblastic disease (GTD) and some of the primary ovarian tumors. The presenting symptoms in patients with these tumors are frequently related to their endocrine activity. The main hormone produced by gestational tropho‐blastic disease is human chorionic gonadotropin (HCG) and the main symptoms are those associated with a normal pregnancy, except they are frequently exaggerated. The endocrinally active ovarian tumors are mainly those of the sex—cord stromal group and these may produce any of the sex steroids (estrogens, androgens, or progestins). Some germ cell tumors of the ovary are hormonally active because they contain syncytio‐trophoblastic cells which produce HCG. There are two specialized types of mature teratomas that are discussed: struma ovarii, which produce thyroid hormones, and carcinoids, which produce serotonin.

Differential diagnoses of hyperandrogenism in a post menopausal woman

“…The excessive local production of oestrogens and androgens by surplus aromatase and 5 alpha reductase activity in adipose tissue is the possible mechanism (7). Ovarian or adrenal tumours produce high levels of androgens and patients usually present with virilization of short duration (9). Adrenal tumours secreting DHEA, DHEAS and rarely testosterone, will cause hyperandrogenic picture and patients with adrenal carcinoma will have high levels of DHEAS (10).…”

Bilateral thecoma presenting as premenopausal hirsutism: Laproscopic removal

“…[5] Other rare ovarian causes of hyperandrogenism include gynandroblastoma, gonadoblastoma, ovarian carcinoid, surface epithelial tumors (Brenner tumor) and metastatic tumors. [6] These tumors are rare representing only 10% of all ovarian tumors.…”

How should postmenopausal androgen excess be evaluated?

“…Ovarian tumours that present with hyperandrogenism include Leydig cell tumours, Sertoli cell tumours, steroid cell tumours -not otherwise specified and ovarian thecomas. 15 These tumours are rare representing only 10% of all ovarian tumours. Less than 150 cases of Leydig cell tumours are reported in the literature.…”