Menopausal Androgen Excess - Associated Cardio-Metabolic Risk: Clues for Ovarian Leydig Cell Tumour (Case Report and Mini-Review of Literature)

Abstract

Background. Ovarian Leydig cell tumour is a very rare steroid hormones producing mass, causing clinical and biochemical hyperandrogenism. Even if the level of evidence is based on case studies, many authors (but not all) agree that raised androgens increase the cardio-metabolic risk thus early diagnosis and treatment are necessary On the other hand, the endocrine features pointing an ovarian tumour source of testosterone do not indicate the specific histological finding which needs a post-operative conformation.Case presentation. We report a case of a 60-yearold woman with a 4-year history of progressive virilisation in association with hypertension, high number of red blood cells, impaired glucose tolerance and dyslipidemia. Total testosterone was 20 times above normal with suppressed gonadotropins, inadequate for menopause. Trans-vaginal ultrasound and pelvic and abdominal computerized axial tomography imaging revealed a right ovarian solid nodule, and no evidence of alteration in the adrenal glands. Total hysterectomy and bilateral salpingo-oophorectomy were performed. Histopathology and immunohistochemistry confirmed the diagnosis of Leydig cell tumour. After surgery, androgen levels returned to normal and the doses of anti-hypertensive drugs were reduced.Conclusions. The hyperandrogenic state with elevated plasma testosterone and progressive signs of virilization raises suspicion of an ovarian androgen-secreting tumor. For a postmenopausal patient with hyperandrogenism the diagnosis of Leydig cell tumour should be considered. However, the exact diagnosis is provided by post-operative histological exam. Prolonged exposure to hyperandrogenism may generate cardiovascular abnormalities and metabolic syndrome which after tumor excision and removal of the source of androgen hormones are expected to significantly improve.

Acanthosis nigricans: To be or not to be afraid (Review)

“…It has been commonly associated with obesity, insulin-resistant diabetes, polycystic ovary disease, hirsutism, Cushing syndrome, Addison disease, hypothyroidism, acromegaly and gigantism. The association of AN with rare diseases such as pinealoma, Cushing pituitary basophilism, ovarian hyperthecosis, stromal luteoma, ovarian dermoid cysts, Prader-Willi syndrome, leprechaunism, lipoatrophic diabetes, pineal hyperplasia syndrome, and Alstrom syndrome has also been described (33–40).…”

Somatostatin receptors in normal and acromegalic somatotroph cells: the U-turn of the clinician to immunohistochemistry report – a review

“…The assessment of SSTRs is part of a larger frame that includes the use of immunochemistry in usual practical approach of tumors that exerts hormonal activity or even those detected as incidentalomas like neuroendocrine neoplasia or ovarian tumors [48][49][50]. NETs represent a large area of diseases located at any organ where a variety of SSTRs combinations are registered [48][49][50][51]. The present of the hormonal receptors at the surface of the tumor allows a new route of therapy including radiolabeled peptides [51].…”