A renin secreting ovarian steroid cell tumour associated with secondary polycythaemia

A 67-year-old woman presented with dry skin, facial hair, hoarse voice, and weight gain. She was hypertensive (168/ 96 mm Hg), her haemoglobin concentration was 19 g/l, and haematocrit was 55.7%. The diagnosis of probable secondary polycythaemia was made. Blood testosterone concentration was 44 nmol/l (normal < 5) and was not suppressed by dexamethasone, suggesting a neoplastic source rather than a pituitary abnormality. Transvaginal ultrasound revealed a hypoechoic solid mass in the left ovary suggestive of a solid ovarian tumour. Hysterectomy and bilateral salpingo-oophorectomy were performed following which testosterone concentration returned to normal. Immunocytochemistry provided evidence of renin synthesis. This is a case of an unusual steroid cell tumour that caused virilisation accompanied by symptoms of secondary polycythaemia presumably as a result of erythropoietin production. This is the second case of a steroid cell tumour with an erythropoietic effect and the first that shows evidence of renin synthesis.