[Why aren't Leydig cell tumors of the ovary diagnosed in time?]

Leydig cell tumor is a rare sex-cord tumor with sex steroid secretion (mostly testosterone). All clinical symptoms and signs are the consequence of extremely high testosterone level. The diagnosis is confirmed using hormone analysis.

A 46-year-old woman with previously normal reproductive function was admitted to the hospital due to hirsutism, temporal hair loss, hoarse voice, increased libido, amenorrhea and clitoromegaly. The examination revealed hirsutism score 36 and signs of defeminization and virilisation. Basal testosterone levels were extremely high before operation, while follicle stimulating hormone and luteinizing hormone were suppressed. Androstenedione was above normal level, while other hormones were normal. Testosterone increased twice in response to Pregnyl. In regard to dexamethasone test there was no response of testosterone, indicating a virilizing ovary tumor. The ultrasound of pelvis was normal. Intraoperatively, a solid 2.3 cm Leydig cell tumor was diagnosed. Testosterone decreased promptly.

This study points to a long-term diagnostic procedure in Leydig cell tumor detection and effects of endogenous testosterone secretion on hypothalamic-pituitary-ovarian axis.