Virilization and metabolic disease in postmenopausal women related to ovarian hyperplasia and hypertecosis
During menopausal transition, mild clinical signs of hyperandrogenism may appear as part of the normal aging process, but the development of frank virilization suggests a specific source of androgen excess. In this context, androgen-secreting tumors at both adrenal and ovarian levels should be ruled...
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| Formato: | Artículo revista |
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Universidad Nacional Cba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2021
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/32136 |
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I10-R10-article-32136 |
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Universidad Nacional de Córdoba |
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Revistas de la UNC |
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Español |
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Artículo revista |
| topic |
virilism diabetes insipidus thecoma virilismo diabetes insípida tecoma virilismo diabetes insípido tecoma |
| spellingShingle |
virilism diabetes insipidus thecoma virilismo diabetes insípida tecoma virilismo diabetes insípido tecoma Larrea, Agustina Lucila González, Vicente Ricardo Knoblovits, Pablo Gil, Santiago José Virilization and metabolic disease in postmenopausal women related to ovarian hyperplasia and hypertecosis |
| topic_facet |
virilism diabetes insipidus thecoma virilismo diabetes insípida tecoma virilismo diabetes insípido tecoma |
| author |
Larrea, Agustina Lucila González, Vicente Ricardo Knoblovits, Pablo Gil, Santiago José |
| author_facet |
Larrea, Agustina Lucila González, Vicente Ricardo Knoblovits, Pablo Gil, Santiago José |
| author_sort |
Larrea, Agustina Lucila |
| title |
Virilization and metabolic disease in postmenopausal women related to ovarian hyperplasia and hypertecosis |
| title_short |
Virilization and metabolic disease in postmenopausal women related to ovarian hyperplasia and hypertecosis |
| title_full |
Virilization and metabolic disease in postmenopausal women related to ovarian hyperplasia and hypertecosis |
| title_fullStr |
Virilization and metabolic disease in postmenopausal women related to ovarian hyperplasia and hypertecosis |
| title_full_unstemmed |
Virilization and metabolic disease in postmenopausal women related to ovarian hyperplasia and hypertecosis |
| title_sort |
virilization and metabolic disease in postmenopausal women related to ovarian hyperplasia and hypertecosis |
| description |
During menopausal transition, mild clinical signs of hyperandrogenism may appear as part of the normal aging process, but the development of frank virilization suggests a specific source of androgen excess. In this context, androgen-secreting tumors at both adrenal and ovarian levels should be ruled out.
We present the case of a 51-year-old postmenopausal woman with signs of 12 month period virilization, associated with personal history of type 2 diabetes and arterial hypertension, poorly managed in the past year. Laboratory tests showed elevation of serum androgen levels and hyperinsulinemia. Images were requested, revealing both enlarged homogeneous and solid ovaries, with preserved adrenal glands, which led to suspicion of a possible thecal hyperplasia of the ovarian stroma. Laparoscopic bilateral adnexectomy was performed and the pathological report confirmed the presumptive diagnosis. One month later after surgery, serum testosterone levels returned to values close to spected for a postmenopausal woman.
Finding the source of virilization in postmenopausal women is challenging, and they are usually associated with rare pathologies. A detailed medical history is essential to differentiate the progressive development of virilization that characterizes benign causes from the rapid progression that characterizes malignant tumors. The adequate interpretation of laboratory tests with complementary images, as well as looking for the association of pathologies causing elevated cardiovascular risk such as diabetes and hypertension are essential to establish a right diagnosis and treatment. |
| publisher |
Universidad Nacional Cba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2021 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/32136 |
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I10-R10-article-321362021-12-29T20:15:49Z Virilization and metabolic disease in postmenopausal women related to ovarian hyperplasia and hypertecosis Virilización y enfermedad metabólica en mujer postmenopáusica relacionado a hiperplasia e hipertecosis ovárica Virilização e doença metabólica em mulheres na pós-menopausa devido à hiperplasia ovariana e hipertecose Larrea, Agustina Lucila González, Vicente Ricardo Knoblovits, Pablo Gil, Santiago José virilism diabetes insipidus thecoma virilismo diabetes insípida tecoma virilismo diabetes insípido tecoma During menopausal transition, mild clinical signs of hyperandrogenism may appear as part of the normal aging process, but the development of frank virilization suggests a specific source of androgen excess. In this context, androgen-secreting tumors at both adrenal and ovarian levels should be ruled out. We present the case of a 51-year-old postmenopausal woman with signs of 12 month period virilization, associated with personal history of type 2 diabetes and arterial hypertension, poorly managed in the past year. Laboratory tests showed elevation of serum androgen levels and hyperinsulinemia. Images were requested, revealing both enlarged homogeneous and solid ovaries, with preserved adrenal glands, which led to suspicion of a possible thecal hyperplasia of the ovarian stroma. Laparoscopic bilateral adnexectomy was performed and the pathological report confirmed the presumptive diagnosis. One month later after surgery, serum testosterone levels returned to values close to spected for a postmenopausal woman. Finding the source of virilization in postmenopausal women is challenging, and they are usually associated with rare pathologies. A detailed medical history is essential to differentiate the progressive development of virilization that characterizes benign causes from the rapid progression that characterizes malignant tumors. The adequate interpretation of laboratory tests with complementary images, as well as looking for the association of pathologies causing elevated cardiovascular risk such as diabetes and hypertension are essential to establish a right diagnosis and treatment. Durante la transición menopáusica pueden aparecer signos clínicos leves de hiperandrogenismo, como parte del proceso de envejecimiento normal, pero el desarrollo de virilización franca sugiere una fuente específica de exceso de andrógenos debiendo descartar la presencia de tumores secretores de andrógenos tanto a nivel adrenal como ovárico. Se presenta un caso de una mujer de 51 años postmenopáusica con signos de virilización de 12 meses de evolución, asociado a antecedente personal de diabetes tipo 2 e hipertensión arterial, de mal manejo en el último año. Las pruebas de laboratorio mostraron una franca elevación de los niveles de andrógeno sérico e hiperinsulinemia asociada. Las imágenes solicitadas evidenciaron ambos ovarios aumentados de tamaño de aspecto homogéneo y sólido, con glándulas adrenales de aspecto conservado, lo que hizo sospechar de una posible hiperplasia tecal del estroma ovárico. Se realizó una anexectomía bilateral por laparoscopia, cuya anatomía patológica confirmó la presunción diagnóstica. Los dosajes de testosterona sérica al mes de la cirugía retornaron a valores cercanos a la normalidad para una mujer postmenopáusica. El diagnóstico causal de virilización en mujeres posmenopáusicas es un desafío, y por lo general están asociadas con patologías poco frecuentes. Una historia clínica detallada es fundamental para diferenciar el desarrollo progresivo de virilización que caracteriza las causas benignas de la rápida progresión que caracteriza a los tumores malignos. La interpretación de pruebas correctas de laboratorio con imágenes complementarias, así como la búsqueda de antecedentes de riesgo cardiovascular como la diabetes y la hipertensión asociadas son fundamentales para establecer un correcto diagnóstico y tratamiento. Durante a transição da menopausa, sinais clínicos leves de hiperandrogenismo podem aparecer como parte do processo normal de envelhecimento, mas o desenvolvimento de virilização franca sugere uma fonte específica de excesso de andrógeno, e a presença de tumores secretores de andrógeno em níveis supra-renais e ovarianos deve ser descartada. Apresentamos o caso de uma mulher em pós-menopausa de 51 anos com sinais de virilização de 12 meses de evolução, associada à história pessoal de diabetes tipo 2 e hipertensão arterial mal gerida no último ano. Os exames laboratoriais mostraram uma elevação evidente dos níveis séricos de andrógenos e hiperinsulinemia associada. As imagens solicitadas revelaram ovários aumentados de tamanho, de aspecto homogêneo e sólido, com glândulas adrenais preservadas, o que levou à suspeita de possível hiperplasia tecal do estroma ovariano. Foi realizada anexectomia laparoscópica bilateral, cuja anatomia patológica confirmou a presunção do diagnóstico. Os níveis de testosterona sérica um mês após a cirurgia voltaram aos valores próximos do normal para uma mulher na pós-menopausa. O diagnóstico causal de virilização em mulheres na pós-menopausa é desafiador e geralmente está associado à patologias raras. Uma história médica detalhada é essencial para diferenciar o desenvolvimento progressivo da virilização que representa as causas benignas da rápida progressão que caracteriza os tumores malignos. A interpretação correta dos exames laboratoriais com imagens complementares, bem como a busca de um histórico de risco cardiovascular como diabetes e hipertensão associada, são essenciais para o estabelecimento de um diagnóstico e tratamento corretos. Universidad Nacional Cba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2021-06-28 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf text/html https://revistas.unc.edu.ar/index.php/med/article/view/32136 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 78 No. 2 (2021); 193-196 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 78 Núm. 2 (2021); 193-196 Revista da Faculdade de Ciências Médicas de Córdoba; v. 78 n. 2 (2021); 193-196 1853-0605 0014-6722 10.31053/1853.0605.v78.n2 spa https://revistas.unc.edu.ar/index.php/med/article/view/32136/33985 https://revistas.unc.edu.ar/index.php/med/article/view/32136/33987 Derechos de autor 2021 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |