Dr Kirsty Fisher1, Dr Melissa Tanner2,3
1Sir Charles Gairdner Hospital, , Australia
2Keogh Institute For Medical Research, Nedlands, Australia
3PathWest Laboratory QEII, Nedlands, Australia
A 46-year-old female was referred with a 2-year history of weight gain, irregular menstruation and progressive virilisation. History included atypical endometrial hyperplasia, polycystic ovarian syndrome, fatty liver, impaired fasting glycaemia, and morbid obesity. Serum testosterone level was 19.3nmol/L (<2.0) with otherwise normal androgens. Luteinizing hormone (LH) and follicle stimulating hormone (FSH) were within normal pre-menopausal reference range, oestradiol 154 pmol/L, progesterone <1 nmol/L. Pelvic ultrasound reported a displaced Mirena, a 5mm myometrial cyst, ill-defined endometrium, and normal ovaries. Computed tomography (CT) abdomen and pelvis was normal. Given the endometrial abnormalities, symptom severity, and patient being within menopausal age, bilateral salpingo-oophorectomy and hysterectomy was considered the best management option. Testosterone rapidly normalised post-operatively. Histopathology revealed dual pathology; bilateral ovarian stromal hyperthecosis and ovarian Leydig cell tumour.
Hyperandrogenism requires careful consideration, particularly with rapid onset symptoms, features of severe androgen excess, overt virilisation, very high androgen levels, or severe insulin resistance. The diagnosis of ovarian androgen-secreting tumours can be difficult, with significant overlap in biochemical and clinical parameters when compared to non-tumour ovarian, adrenal, or metabolic-associated hyperandrogenism. In addition, they are frequently radiologically occult. Although commonly benign, they are associated with significant morbidity and are curable with surgical resection.
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.