Hyperandrogenism due to a testosterone-secreting Sertoli-Leydig cell tumor associated with a dehydroepiandrosterone sulfate-secreting adrenal adenoma in a postmenopausal woman: case presentation and review of literature.

Abstract

OBJECTIVE:

To report a case of hyperandrogenism attributable to the presence of an adrenal adenoma secreting dehydroepiandrosterone sulfate (DHEA-S) and an ovarian Sertoli-Leydig cell tumor secreting testosterone in a postmenopausal woman.

METHODS:

The laboratory, radiologic, and pathologic findings in our case are described. In addition, the pertinent literature is reviewed.

RESULTS:

A 56-year-old woman presented with a history of gradual increase in facial and body hair, scalp hair loss, male pattern baldness, and deepening of her voice, beginning a few years after spontaneous menopause at age 49 years. She had hypertension, obesity, and type 2 diabetes mellitus. Laboratory tests showed elevated levels of total testosterone (348 ng/dL) and DHEA-S (2,058 microg/dL), and a left adrenal tumor (3 by 4 cm) was detected on abdominal computed tomographic scan. Laparoscopic left adrenalectomy was performed, and the pathologic diagnosis was adrenal adenoma. The DHEA-S returned to normal levels, but the serum testosterone concentration remained elevated. Transvaginal ultrasonography disclosed an ovarian tumor. Bilateral oophorectomy was performed, and an ovarian Sertoli-Leydig cell tumor was diagnosed. The hormonal and clinical picture normalized after this surgical intervention.

CONCLUSION:

After extensive review of the literature, we believe that this is the first reported case of a coincidental DHEA-S-secreting adrenal adenoma and a testosterone- secreting ovarian Leydig cell tumor causing signs of virilization.

• Authors: Jorge D Herrera, Jaime A Davidson, Jorge H Mestman
• Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (Endocr Pract) Vol. 15 Issue 2 Pg. 149-52 (Mar 2009) ISSN: 1934-2403 [Electronic] United States
• PMID: 19289327 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Testosterone
• Dehydroepiandrosterone Sulfate

Topics

• Adrenocortical Adenoma (metabolism, pathology, physiopathology)
• Alopecia
• Dehydroepiandrosterone Sulfate (metabolism)
• Female
• Humans
• Hyperandrogenism (diagnosis, etiology, pathology)
• Leydig Cell Tumor (metabolism, pathology, physiopathology)
• Middle Aged
• Postmenopause
• Testosterone (metabolism)