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Exp Clin Endocrinol Diabetes 2010; 118(5): 291-297
DOI: 10.1055/s-0029-1225351
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Leydig-Cell-Tumor of the Ovary that Responded to GnRH-Analogue Administration – Case Report and Review of the Literature

R. K. Klotz2 , E. Müller-Holzner1 , S. Fessler1 , D. U. Reimer1 , I. Zervomanolakis2 , B. Seeber2 , V. Mattle2 , L. Wildt2
  • 1Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
  • 2Department of Gynecologic Endocrinology and Reproductive Medicine, Innsbruck Medical University, Innsbruck, Austria
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Publication History

received 19.10.2008 first decision 01.04.2009

accepted 25.05.2009

Publication Date:
02 March 2010 (online)

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Abstract

Progressive hirsutism can be a symptom of an androgen-producing tumor, especially in postmenopausal women. We report a case of a 58-year-old woman who complained of progressive hirsutism, nervousness, irritability, anxiousness and an increased libido. Examination showed an unusual redness of her head, décolleté, palms and soles of her feet. Basal laboratory tests revealed a profound elevation of testosterone levels (7.5 μg/l) and normal levels of androstendione, dehydroepiandrosterone-sulfate, 17α-hydroxy-progesterone and thyroid-stimulating hormone. Also remarkable was that her red blood count, hemoglobin and hematocrit values were elevated while erythropoietin was within normal limits. Functional laboratory tests ruled out heterozygous C21-hydroxylase deficiency and showed a moderate insulin resistance on the oral glucose tolerance test. Transvaginal ultrasound revealed a slightly hyperdensic area of 6 mm in the left ovary. Magnetic resonance imaging showed a contrast medium-accumulating area of 2 cm in the left ovary. Since the patient was initially reluctant to undergo surgery, a GnRH-analogue (triptoreline) was administered via intramuscular injection once per month for two months and testosterone levels were lowered to less than one third of the initial level (2 μg/l). Surgery was eventually performed with laparoscopic bilateral salpingoophorectomy, hysteroscopy and uterine curettage. The histologic examination revealed a Leydig cell tumor in the hilus and stroma of the left ovary. Postoperatively testosterone levels dropped dramatically and instantly into the normal range. Within months, the red blood count and hematocrit levels were within normal limits. The patient's face became more feminine, the redness of her face and hirsutism regressed. Her anxiousness and nervosity resolved and the insulin sensitivity improved. In this paper, polyglobulia, the metabolic and psychological changes due to hyperandrogenism are discussed, as well as the phenomenon that the tumor responded to a GnRH-analogue. Such a response implies that the tumor is either under gonadotropin control or that GnRH analogues have direct effects via receptors on tumorous Leydig cells.

Key words

hyperandrogenemia - androgen-producing tumor - leydig-cell tumor - GnRH-analoga

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Correspondence

L. WildtMD 

Department of Gynecologic

Endocrinology and Reproductive Medicine

Innsbruck Medical University

Anichstraße 35

6020 Innsbruck

Phone: +43/512/504 23276

Fax: +43/512/504 23277

Email: Ludwig.Wildt@i-med.ac.at