Total testosterone levels are often more than three times elevated in patients with androgen-secreting tumours

Glintborg, Dorte; Altinok, Magda Lambaa; Petersen, Kathrine Birch; Ravn, Pernille

doi:10.1136/bcr-2014-204797

Cited by 13 publications

(7 citation statements)

References 44 publications

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“…Only three of them had severe hyperandrogenemia [ 3 , 7 , 8 ]. In our patient, circulating total testosterone levels were on male range, a feature associated to other androgen-secreting neoplasms and germ cell tumours [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Virilization of a postmenopausal woman by a mucinous cystoadenoma

Díaz

Piñero

Nattero‐Chávez

et al. 2018

Oxford Medical Case Reports

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ObjectiveTo describe the case of the most hyperandrogenaemic ovarian mucinous cystadenoma reported to date.MethodsWe present the clinical, laboratory and radiologic findings in a patient with an unusual diagnosis according to age and the clinical behaviour of the tumour, as well as a review of relevant literature.ResultsA 77-year-old women came to our consult because of fronto-parietal alopecia and an augmentation of the abdominal perimeter since 1 year ago. Clitoromegaly was observed during the physical examination. Hormonal analysis showed elevated testosterone and dehydroepiandrostenerone-sulphate levels (659 ng/dL and 1950 ng/ml, respectively), and imaging examination described an andexal cystic mass dependent on the right ovary. Pathological diagnosis was “mucinous cystoadenoma”. After surgery, clinical and analytical alterations were normalized.ConclusionAlthough ovarian mucinous cystadenomas are classically classified as “nonfunctional” tumours, they exceptionally can act as functional, and produce testosterone levels as high as directly secreting hormones or germ cell tumours.

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Section: Discussionmentioning

confidence: 99%

Virilization of a postmenopausal woman by a mucinous cystoadenoma

Díaz

Piñero

Nattero‐Chávez

et al. 2018

Oxford Medical Case Reports

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“…First-line investigations should include at least serum testosterone, dehydroepiandrosterone-sulfate (DHEA-S) and 17-hydroxyprogesterone (17OHP). Serum total testosterone levels are often more than 3 times elevated in patients with androgen-secreting ovarian tumors ( 26 ). DHEA-S (and adrenal androgen precursors such as DHEA and androstenedione together with glucocorticoids) are markedly elevated with adrenal tumors ( 27 ).…”

Section: Clinical Evaluationmentioning

confidence: 99%

Approach to the Virilizing Girl at Puberty

Santi

Graf

Zeino

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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Virilization is the medical term for describing a female who develops characteristics associated with male hormones (androgens) at any age, or when a newborn girl shows signs of prenatal male hormone exposure at birth. In girls, androgen levels are low during pregnancy and childhood. A first physiologic rise of adrenal androgens is observed at the age of 6-8 years and reflects functional activation of the zona reticularis of the adrenal cortex at adrenarche manifesting clinically with first pubic and axillary hairs. Early adrenarche is known as ‘premature adrenarche’. It is mostly idiopathic and of uncertain pathologic relevance but requires the exclusion of other causes of androgen excess (e.g. non-classic congenital adrenal hyperplasia) that might exacerbate clinically into virilization. The second modest physiologic increase of circulating androgens occurs then during pubertal development which reflects the activation of ovarian steroidogenesis contributing to the peripheral androgen pool. However, at puberty initiation (and beyond) ovarian steroidogenesis is normally devoted to estrogen production for the development of secondary female bodily characteristics (e.g. breast development). Serum total testosterone in a young adult woman is therefore about 10-20-fold lower than in a young man, while midcycle estradiol is about 10-20-fold higher. But if androgen production starts too early, progresses rapidly and in marked excess (usually more than 3-5 times above normal), females will manifest with signs of virilization such as masculine habitus, deepening of the voice, severe acne, excessive facial and (male typical) body hair, clitoromegaly and increased muscle development. Several medical conditions may cause virilization in girls and women including androgen-producing tumors of the ovaries or adrenal cortex, (non-)classical congenital adrenal hyperplasia (CAH) and, more rarely, other disorders (also referred to as differences) of sex development (DSD). The purpose of this article is to describe the clinical approach to the girl with virilization at puberty, focussing on diagnostic challenges. The review is written from the perspective of the case of an 11.5-year-old girl who was referred to our clinic for progressive, rapid onset clitoromegaly, and was then diagnosed with a complex genetic form of DSD that led to abnormal testosterone production from a dysgenetic gonad at onset of puberty. Her genetic workup revealed a unique translocation of an abnormal duplicated Y-chromosome to a deleted chromosome 9, including the Doublesex and Mab-3 Related Transcription factor 1 (DMRT1) gene.

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“…Abnormally elevated serum androgens are associated with malignancy; however, there is variability in the recommended cutoff levels to prompt suspicion for an androgen-producing tumor and further workup in postmenopausal women. 7 In the case of testosterone elevation, classic teaching designates a testosterone level greater than 200 ng/dL as the appropriate threshold for concern, but this level is now debated. In a series of women with hyperandrogenism referred to a center for suspicion of an androgen-secreting tumor, those with a tumor had, on average, a significantly higher (260 ng/dL) testosterone level than women who had other causes (90 ng/dL)(P<.05).…”

Section: Practice Pointsmentioning

confidence: 99%