Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women?

• Published in: Clinical endocrinology (Oxford) 2003-07, Vol.59 (1), p.34-43
• Main Authors: Kaltsas, G. A., Mukherjee, J. J., Kola, B., Isidori, A. M., Hanson, J. A., Dacie, J. E., Reznek, R., Monson, J. P., Grossman, A. B.
• Format: Article
• Language: English
• Subjects: Adrenal Gland Neoplasms - complications; Adrenal Gland Neoplasms - diagnostic imaging; Adrenal Glands - blood supply; Adrenal Glands - diagnostic imaging; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Androstenedione - blood; Biological and medical sciences; Blood Specimen Collection - methods; Catheterization - statistics & numerical data; Dehydroepiandrosterone Sulfate - blood; Dexamethasone; Endocrinopathies; Female; Glucocorticoids; Humans; Hyperandrogenism - blood; Hyperandrogenism - etiology; Medical Audit; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Ovarian Neoplasms - complications; Ovarian Neoplasms - diagnostic imaging; Ovary - blood supply; Ovary - diagnostic imaging; Polycystic Ovary Syndrome - complications; Polycystic Ovary Syndrome - diagnostic imaging; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Testosterone - blood; Tomography, X-Ray Computed; Ultrasonography
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1046/j.1365-2265.2003.01792.x

Summary objective To audit our practice of performing ovarian and adrenal venous catheterization and sampling in hyperandrogenic women who fail to suppress their elevated androgen levels following a 48‐h low‐dose dexamethasone suppression test (LDDST). We considered the technical success rate of catheterization, the extra information obtained in addition to the standard biochemical tests and imaging findings, and the impact of sampling on management decisions. design A retrospective analysis of the results of all ovarian and adrenal venous catheterizations performed at St Bartholomew's Hospital, London, in the years 1980–1996. patients and methods  Baseline ovarian and adrenal androgens were measured in all women presenting with symptoms and signs of hyperandrogenism. Those patients who failed to suppress their elevated testosterone (T), androstenedione (A4) and/or dehydroepiandrosterone‐sulphate (DHEAS) levels following a LDDST to within the normal range or to less than 50% of the baseline value were investigated further with adrenal computed tomography (CT), ovarian ultrasound, and ovarian and adrenal venous catheterization and sampling. results Results were available in 38 patients. The overall catheterization success rate was: all four veins in 27%, three veins in 65%, two veins in 87%. The success rate for each individual vein was: right adrenal vein (RAV) 50%, right ovarian vein (ROV) 42%, left adrenal vein (LAV) 87% and left ovarian vein (LOV) 73%. Eight patients were found to have tumours by means of imaging (adrenal CT and ovarian ultrasound), three adrenal and five ovarian, seven of which underwent operation. In six of these patients the clinical presentation was suggestive of the presence of a tumour; in addition, the combination of imaging findings allowed the detection of suspicious adrenal and ovarian masses in all eight cases. The five patients with ovarian tumours had serum testosterone levels > 4·5 nmol/l. In a further eight patients, laparotomy was performed based on a combination of diagnostic and therapeutic indications; in two of these patients the catheterization results were suggestive of an ovarian tumour. All these eight patients were shown histologically to have polycystic ovarian syndrome (PCOS), and no occult ovarian tumour was identified. None of the patients with nontumourous hyperandrogenism had a baseline testosterone level in excess of 7 nmol/l (median 4·4 nmol/l, range 2·5–7 nmol/l). conclusions Our results suggest that ov