Bilateral microscopic Leydig cell ovarian tumors in the postmenopausal woman

A 64-year-old postmenopausal female patient presented with approximately 5 years of intermittent spotting, progressive hirsutism and significantly increased libido and clitoral hypersensitivity with spontaneous orgasms multiple times a day beginning a few months prior. Initial hormone work-up reveal...

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Bibliographic Details
Published in:BMJ case reports 2020-12, Vol.13 (12), p.e236427
Main Authors: Langevin, Taylor L, Maynard, Karen, Dewan, Anil
Format: Article
Language:English
Subjects:
17-alpha-Hydroxyprogesterone - blood
Abdomen
Adrenal glands
Alopecia
Androgens
Androstenedione - blood
Baldness
Case reports
Clitoris
Endometrium
Fallopian tubes
Female
gynaecological cancer
Gynecological cancer
Gynecology
Hirsutism - etiology
Humans
Hyperplasia
Laparoscopy
Leydig Cell Tumor - blood
Leydig Cell Tumor - complications
Leydig Cell Tumor - diagnosis
Leydig Cell Tumor - surgery
menopause (including HRT)
Middle Aged
Oophorectomy
Ovarian cancer
Ovarian Neoplasms - blood
Ovarian Neoplasms - complications
Ovarian Neoplasms - diagnosis
Ovarian Neoplasms - surgery
Ovaries
Ovary - pathology
Ovary - surgery
Postmenopause
Rare Disease
reproductive medicine
Salpingo-oophorectomy
Surgery
Testosterone
Testosterone - blood
Thyroid gland
Treatment Outcome
Tumors
Ultrasonic imaging
Uterus
Womens health
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Description
Summary:A 64-year-old postmenopausal female patient presented with approximately 5 years of intermittent spotting, progressive hirsutism and significantly increased libido and clitoral hypersensitivity with spontaneous orgasms multiple times a day beginning a few months prior. Initial hormone work-up revealed elevated total serum testosterone, androstenedione and 17-hydroxyprogesterone. Luteinising hormone, follicle stimulating hormone, estradiol, dehydroepiandrosterone-sulfate, thyroid stimulating hormone and prolactin were all within normal limits. Initial suspicions suggested an androgen-secreting tumour, likely in the ovary. The lesion was undetectable on transvaginal ultrasound and abdominal–pelvic CT scan. Laparoscopic bilateral salpingo-oophorectomy was performed to remove the likely source of excess androgens. Visible gross lesions were not observed intraoperatively; however, bilateral Leydig (hilus cell) tumours were confirmed by histopathology. Serum testosterone, androstenedione and 17-hydroxyprogesterone levels were normalised postoperatively within 2 weeks and 1 month, respectively.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-236427