Ovarian hyperthecosis, diabetes and hirsuties in post‐menopausal women

Barth, Julian H.; Jenkins, Melvin E.; Belchetz, P. E.

doi:10.1046/j.1365-2265.1997.1050916.x

Cited by 65 publications

(48 citation statements)

References 26 publications

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“…Women with OH typically present with a long history of slowly progressive hyperandrogenism often resulting in virilization. Their hormonal profile is characterized by markedly increased serum testosterone levels (O150 ng/dl) in the absence of other elevated androgens, accompanied with high gonadotropin levels (39,40,41); ultrasound examination usually reveals bilaterally bigger than normal postmenopausal ovaries (mean size 7.7G2.3 vs 2.3G0.01 ml respectively) (39,42,43). The diagnosis is confirmed histologically demonstrating the characteristic nests of differentiated ovarian interstitial cells into steroidogenically active luteinized stromal cells throughout the ovarian stroma (44).…”

Section: Ovarian Hyperthecosismentioning

confidence: 81%

“…In the majority of patients, severe IR and hyperinsulinemia occurs, enhancing ovarian androgen production and leading to clinical manifestations such as central obesity, skin tags, and acanthosis nigricans (45). Overall, the hormonal and metabolic aberrations related to OH contribute significantly to an increased risk for type 2 diabetes and CVD (39,46), while the extensive peripheral aromatization of androgens increases the risk for endometrial hyperplasia and carcinoma (47).…”

Section: Ovarian Hyperthecosismentioning

confidence: 99%

“…Ovarian hyperthecosis (OH) is a non-neoplastic disorder mainly diagnosed in postmenopausal women mimicking the clinical manifestations and metabolic sequel of PCOS (15,39). Although the precise etiology is not known, it is thought to be related to elevated postmenopausal gonadotropin levels (40).…”

Section: Ovarian Hyperthecosismentioning

confidence: 99%

See 2 more Smart Citations

MANAGEMENT OF ENDOCRINE DISEASE: Hyperandrogenism after menopause

Markopoulos

Kassi

Alexandraki

et al. 2015

European Journal of Endocrinology

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Postmenopausal hyperandrogenism is a state of relative or absolute androgen excess originating from either the adrenals and/or the ovaries, clinically manifested as the appearance and/or increase in terminal hair growth or the development of symptoms/signs of virilization. In either settings, physicians need to evaluate such patients and exclude the presence of the relatively rare but potentially life-threatening underlying tumorous causes, particularly adrenal androgen-secreting tumors. It has been suggested that the rapidity of onset along with severity of symptom and the degree of androgen excess followed by relevant imaging studies may suffice to identify the source of excessive androgen secretion. However, up to date, there is no consensus regarding specific clinical and hormonal indices and/or imaging modalities required for diagnostic certainty. This is particularly relevant as the aging population is increasing and more cases of postmenopausal women with clinical/biochemical evidence of hyperandrogenism may become apparent. Furthermore, the long-term sequels of nontumorous hyperandrogenism in postmenopausal women in respect to cardiovascular morbidity and mortality still remain unsettled. This review delineates the etiology and pathophysiology of relative and absolute androgen excess in postmenopausal women. Also, it attempts to unravel distinctive clinical features along with specific hormonal cut-off levels and/or appropriate imaging modalities for the facilitation of the differential diagnosis and the identification of potential long-term sequels.

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Section: Ovarian Hyperthecosismentioning

confidence: 81%

Section: Ovarian Hyperthecosismentioning

confidence: 99%

See 1 more Smart Citation

MANAGEMENT OF ENDOCRINE DISEASE: Hyperandrogenism after menopause

Markopoulos

Kassi

Alexandraki

et al. 2015

European Journal of Endocrinology

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show abstract

“…congenital adrenal hyperplasia (CAH) (10). Ovarian hyperthecosis presents similarly to PCOS, and the two diagnoses can be difficult to distinguish (11,12). Features of hyperandrogenism in ovarian hyperthecosis persist beyond the menopause, and indeed, ovarian hyperthecosis may account for the majority of cases of post-menopausal hyperandrogenaemia.…”

Section: Introductionmentioning

confidence: 99%

“…Features of hyperandrogenism in ovarian hyperthecosis persist beyond the menopause, and indeed, ovarian hyperthecosis may account for the majority of cases of post-menopausal hyperandrogenaemia. Women with hyperthecosis also have severe hirsutism and other clinical evidence of virilization not seen in PCOS such as cliteromegaly, temporal balding and deepening of the voice (11,12).…”

Section: Introductionmentioning

confidence: 99%

Investigation of patients with atypical or severe hyperandrogenaemia including androgen-secreting ovarian teratoma

Dennedy

Smith²,

O’Shea³

et al. 2010

European Journal of Endocrinology

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Approximately 7% of women of reproductive age manifest polycystic ovary syndrome (PCOS) and !0.5% have other causes of hyperandrogenism including congenital adrenal hyperplasia (CAH), androgen-secreting tumour of an ovary or an adrenal gland, Cushing's syndrome or hyperthecosis. The presence of features atypical of PCOS should prompt more extensive evaluation than that usually undertaken. Features atypical of PCOS include the onset of symptoms outside the decade of 15-25 years, rapid progression of symptoms, the development of virilization and a serum testosterone concentration in excess of twice the upper limit of the reference range. Ethnic background, family history and specific clinical findings, e.g. Cushingoid appearance, may inform a focused investigation. Otherwise, patients should have measurement of 17-hydroxyprogesterone (17-OHP) under basal conditions ideally in the early morning, and if abnormal, they should have measurement of 17-OHP one hour after the administration of synthetic ACTH, 250 mg i.v., to screen for CAH, which is present in w2% of hyperandrogenic patients. The overnight cortisol suppression test employing 1 mg dexamethasone at midnight is a sensitive test for Cushing's syndrome. Coronal tomographic (CT) scanning of the adrenals and transvaginal ultrasonography of the ovaries are the investigations of choice when screening for tumours in these organs. Less frequently required is catheterization and sampling from both adrenal and ovarian veins, which is a technically demanding procedure with potential complications which may provide definitive diagnostic information not available from other investigations. Illustrative case reports highlight some complexities in the investigation of hyperandrogenic patients presenting with features atypical of PCOS and include only the ninth case report of an androgen-secreting ovarian teratoma.

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OC207: Ovarian stromal hyperthecosis: sonographic features and histological associations

Brown

Henrichsen

Clayton

et al. 2007

Ultrasound in Obstet & Gyne

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Oral communication abstractsConclusions: On ultrasound GCT is characterized by a large multilocular or solid mass with a large number of locules and increased vascularization; it rarely has papillarities. OC207 Mayo Clinic, United StatesObjectives: Ovarian causes of virilization include polycystic ovary syndrome (PCOS), androgen-secreting neoplasms and ovarian stromal hyperthecosis (SH). The ultrasound features of the first two causes have been described, but there is little published data regarding the ultrasound appearance of ovarian stromal hyperthecosis. The primary purpose of this study was to describe the sonographic features of ovarian SH. Methods: A computerized search of our institution's pathology and imaging databases from 1996 to 2006 was performed to identify patients with histologically proven SH who had a pelvic ultrasound scan before surgery. The ultrasound images were reviewed to categorize the ultrasound findings. Associated pathological findings in the ovaries and uterus were also noted. Results: Sixteen ovaries with SH, in 12 patients with mean age 59.6 (range, 36-83) years, were identified. SH was bilateral in four, unilateral in six and of uncertain laterality in two patients who only had a unilateral oophorectomy. Ultrasound findings in the 16 ovaries with SH were: two normal, seven not seen, three enlarged but otherwise normal, one with a hemorrhagic cyst (resolved by surgery) and otherwise normal, one with a probable solid mass (nodular SH), and two with polycystic ovaries (both SH and PCOS by histology). Three of the 12 patients (25%) also had endometrial carcinoma. Five of the 12 patients (42%) also had an ovarian fibrothecoma. Conclusions: Ovarian SH does not have recognizable ultrasound findings in most patients. A minority of affected ovaries appear enlarged but otherwise normal, a solid mass may infrequently be visible, and PCOS changes may coexist with SH. A possible association of SH with endometrial carcinoma was noted, and has been reported previously. A possible association of SH with fibrothecoma was also noted, which to our knowledge has not been reported previously. Objectives: To assess the performance of the power Doppler index (PDI) compared to subjective judgment of the ultrasonographer in the preoperative diagnosis of ovarian malignancy. Methods: Eighty-two successive complex adnexal masses were examined prospectively with power Doppler before surgical treatment. The investigation was multicentric and included in a large contrast-enhanced ultrasound European study. A vascularity index based on the number of colored pixels, was estimated on selected frames (defined region of interest covering the entire tumor) of the tumors using an in-house color quantifying program. The sensitivity and specificity of PDI, the resistance index and subjective visual scoring were compared using receiver-operating characteristic (ROC) curves. Results: Histology identified 34 malignant tumors including 11 borderline tumors and 48 benign tumors. PDI was considerably higher in malignant tha...

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Ovarian hyperthecosis, diabetes and hirsuties in post‐menopausal women

Cited by 65 publications

References 26 publications

MANAGEMENT OF ENDOCRINE DISEASE: Hyperandrogenism after menopause

MANAGEMENT OF ENDOCRINE DISEASE: Hyperandrogenism after menopause

Investigation of patients with atypical or severe hyperandrogenaemia including androgen-secreting ovarian teratoma

OC207: Ovarian stromal hyperthecosis: sonographic features and histological associations

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