Leydig-Cell-Tumor of the Ovary that Responded to GnRH-Analogue Administration – Case Report and Review of the Literature

Abstract

Progressive hirsutism can be a symptom of an androgen-producing tumor, especially in postmenopausal women. We report a case of a 58-year-old woman who complained of progressive hirsutism, nervousness, irritability, anxiousness and an increased libido. Examination showed an unusual redness of her head, décolleté, palms and soles of her feet. Basal laboratory tests revealed a profound elevation of testosterone levels (7.5 microg/l) and normal levels of androstendione, dehydroepiandrosterone-sulfate, 17alpha-hydroxy-progesterone and thyroid-stimulating hormone. Also remarkable was that her red blood count, hemoglobin and hematocrit values were elevated while erythropoietin was within normal limits. Functional laboratory tests ruled out heterozygous C21-hydroxylase deficiency and showed a moderate insulin resistance on the oral glucose tolerance test. Transvaginal ultrasound revealed a slightly hyperdensic area of 6 mm in the left ovary. Magnetic resonance imaging showed a contrast medium-accumulating area of 2 cm in the left ovary. Since the patient was initially reluctant to undergo surgery, a GnRH-analogue (triptoreline) was administered VIA intramuscular injection once per month for two months and testosterone levels were lowered to less than one third of the initial level (2 microg/l). Surgery was eventually performed with laparoscopic bilateral salpingoophorectomy, hysteroscopy and uterine curettage. The histologic examination revealed a Leydig cell tumor in the hilus and stroma of the left ovary. Postoperatively testosterone levels dropped dramatically and instantly into the normal range. Within months, the red blood count and hematocrit levels were within normal limits. The patient's face became more feminine, the redness of her face and hirsutism regressed. Her anxiousness and nervosity resolved and the insulin sensitivity improved. In this paper, polyglobulia, the metabolic and psychological changes due to hyperandrogenism are discussed, as well as the phenomenon that the tumor responded to a GnRH-analogue. Such a response implies that the tumor is either under gonadotropin control or that GnRH analogues have direct effects via receptors on tumorous Leydig cells.

The Effect of Erythropoietin on Progesterone Levels during Ischemia Reperfusion Injury in Rats

“…Mahmoodi M et al found 5 the mean total volume of ovary, cortex, medulla and the number of follicles significantly increased in the grafts +EPO group (p < 0.01) than control one. Trošt N et al analyzed 6 11 polyglobulia and a Leydig cell tumor in the hilus and stroma of the left ovary in a 58-year-old woman whose basal laboratory tests were normal for levels of 17alpha-hydroxy-progesterone and EPO. Kwon BK et al reviewed 12 the available neuroprotective therapies including EPO and progesterone administered for acute SCI.…”

Hormonaktive Ovarialtumoren

“…Im Falle von Metastasen kann eine platinbasierte Chemotherapie verabreicht werden, auch wenn valide, prospektive Daten zu ihrer Wirksamkeit fehlen [1]. Interessanterweise gibt es auch Fallberichte, die von einem Ansprechen der Erkrankung auf GnRH Analoga berichten [5,11].…”

Androgenproduzierende Tumoren

“…Eine neu aufgetretene, sich rasch entwickelnde ausgeprägte Virilisierung mit exzessiver Hyperandrogenämie ist bis zum Beweis des Gegenteils tumorverdächtig [3]. Tritt ein deutlicher Hirsutismus erstmals in der Postmenopause auf, so ist dies häufig ein klinisches Zeichen für einen androgenproduzierenden Tumor [4]. Des Weiteren wird die Bestimmung von Androstendion sowie von Dehydroepiandrosteronsulfat (DHEAS) empfohlen [9], das bei Frauen als Prohormon des Testosterons zu 90% in der NNR und zu 10% in den Ovarien produziert wird.…”

“…Bei postmenopausalen Patientinnen und nachgewiesener ovarieller Neoplasie wird eine beidseitige Adnexektomie durchgeführt. Bei Malignität wird stadiengerecht vorgegangen.E Eine organerhaltende Resektion wird bei Frauen im reproduktionsfähigen Alter angestrebt.Bei androgenproduzierenden Ovarialtumoren mit Tumorzellen, die Gonadotropinrezeptoren exprimieren, kann eine therapeutische Androgensuppression durch Einsatz von GnRH-Analoga wie Triptorelin erzielt werden[4]. Wird ein androgenbildender Tumor der NNR diagnostiziert, kann dieser ebenfalls laparoskopisch exstirpiert werden.…”