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Selective ovarian vein sampling to localize a Leydig cell tumor
Ryan D Dickerson1, Michael J Putman, Michael E Black
1Department of Obstetrics and Gynecology, Dallas, Texas, USA.
Fertility and Sterility
|July 13, 2005
Summary
A 32-year-old woman with rapid virilization was diagnosed with an androgen-secreting left ovarian Leydig cell tumor. Selective ovarian vein catheterization and hormonal sampling successfully localized the tumor, leading to its removal and normalization of testosterone levels.
Area of Science:
- Endocrinology
- Gynecologic Oncology
- Diagnostic Imaging
Background:
- Virilization in women can be caused by androgen-secreting ovarian tumors.
- Early and accurate diagnosis is crucial for effective management.
Observation:
- A 32-year-old woman presented with rapid, 4-month onset of virilizing symptoms.
- Elevated serum total testosterone (1,505 ng/dL) and free testosterone (234 ng/dL) were noted.
Findings:
- Transvaginal ultrasound and CT imaging were followed by selective ovarian vein catheterization and hormonal sampling (SOVHS).
- SOVHS revealed significantly elevated testosterone in the left ovarian vein (20,967 ng/dL) compared to the right (1,351 ng/dL).
- A left ovarian Leydig cell tumor was surgically removed via laparoscopy, resulting in a rapid decrease in testosterone levels to 11 ng/dL within 3 months.
Implications:
- Selective ovarian vein catheterization and hormonal sampling is an effective method for localizing small androgen-secreting ovarian tumors.
- This technique aids in precise diagnosis and surgical planning for rare endocrine disorders.
- Prompt surgical intervention leads to rapid reversal of virilizing symptoms.