Dr Kirsty Fisher1, Dr Meg Henze1
1Sir Charles Gairdner Hospital, Australia
A 59-year-old post-menopausal female was referred with a 3-year history of weight gain and progressive virilisation. Initial serum testosterone was 4.4 nmol/L (<2) with increased androstenedione, mildly increased 17-hydroxy-progesterone and impaired fasting glucose. Abdominopelvic computed tomography (CT) revealed a left adrenal adenoma and left adnexal mass consistent with left ovary. 24-hour urinary free cortisol, 1mg dexamethasone suppression test, serum metanephrines and aldosterone:renin ratio were normal. Pelvic ultrasound and magnetic resonance imaging did not show ovarian enlargement. A modified gonadotropin releasing hormone (GNRH) suppression test suppressed androgen production. The patient proceeded to oophorectomy. Histopathology revealed ovarian stromal hyperplasia and hyperthecosis. 3 months post-operatively her androgen profile had normalised.
Ovarian hyperthecosis is a non-neoplastic disorder predominantly affecting post-menopausal women. There is a gradual and often severe increase in testosterone without significant increases in other androgens. Peripheral aromatisation of androgens increases the risk for endometrial hyperplasia and carcinoma. In addition, there is a complex interplay between pituitary luteinizing hormone (LH) secretion, ovarian stroma proliferation, insulin resistance and obesity. This contributes to an increased risk for type 2 diabetes mellitus and cardiovascular disease that often persists despite correction of the androgen profile.
Biography:
Dr Kirsty Fisher is an Advanced Trainee in Endocrinology in Western Australia. She completed her medical degree at the University of Otago before moving to Western Australia in 2009. She completed her Advanced Training in General Medicine but was drawn to Endocrinology and has returned to training. She enjoys all aspects of general endocrinology and has an interest in reproductive endocrinology and metabolic medicine.