Intraoperative testosterone assay for virilizing ovarian tumor topographic assessment: Report of a leydig cell tumor of the ovary in a premenopausal woman with an adrenal incidentaloma

• Published in: The journal of clinical endocrinology and metabolism Vol. 87; no. 7; pp. 3074 - 3077
• Main Authors: REGNIER, C, BENNET, A, MALET, D, GUEZ, T, PLANTAVID, M, ROCHAIX, P, MONROZIES, X, LOUVET, J.-P, CARON, P
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.07.2002
• Subjects: Adult; Biological and medical sciences; Female; Female genital diseases; Functional investigation of endocrine glands and genital system; Gynecology. Andrology. Obstetrics; Hirsutism - etiology; Humans; Intraoperative Period; Investigative techniques, diagnostic techniques (general aspects); Leydig Cell Tumor - blood; Leydig Cell Tumor - complications; Leydig Cell Tumor - pathology; Leydig Cell Tumor - surgery; Medical sciences; Osmolar Concentration; Ovarian Neoplasms - blood; Ovarian Neoplasms - complications; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Polycystic Ovary Syndrome - complications; Testosterone - blood; Tumors; Endocrinopathy; Skin disease; Adrenal glands; Blood plasma; Ovary; Virilizing; Association; Surgery; Adrenal gland diseases; Vena ovarica; Adult; Female; Tumor; Testicular hormone; Hormonal investigation; Localization; Human; Hair; Androgen; Ovariectomy; Hirsutism; Intraoperative; Female genital diseases; Case study; Ovarian diseases; Testosterone; Virilism; Incidentaloma; Sex steroid hormone
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.87.7.3074

Ovarian virilizing tumors are rare and can lead to assessment difficulties because of their small size. A 41-yr-old female was referred for evaluation of hirsutism that had increased within the previous 3 yr. Menstrual cycle length was normal. Plasma testosterone was 3.9 ng/ml (normal range, 0.2-0.8 ng/ml), was not suppressible by 2 mg dexamethasone (4.3 ng/ml), and was increased (6.3 ng/ml) after three daily injections of hCG (5000 IU). Abdominal computed tomography scan showed an adrenal nodule (13 x 6 mm) that remained unchanged after 3 months. Ultrasound examination of the pelvis was normal. Ovarian and adrenal venous catheterization did not yield additional information. Topographic assessment was made by intraoperative measurement of testosterone in the samples taken from each ovarian vein (competitive chemiluminescent immunoassay ADVIA Centaur; right ovarian vein, 105 ng/ml; left ovarian vein, 5 ng/ml; peripheral blood, 7 ng/ml). Right annexectomy resulted in normalization of testosterone levels (0.22 ng/ml). Histopathological examination found a Leydig cell tumor of hilar type (1.5 cm). This observation illustrates the usefulness of intraoperative measurement of testosterone by a rapid automated technique for topographic assessment of ovarian virilizing tumor in premenopausal women.