Characterization of gonadotrophin receptors in a testosterone-producing ovarian androblastoma. Case report

Testosterone-secreting gonadotropin-responsive adrenal adenoma and its treatment with the antiandrogen flutamide

A 55-year-old woman with virilization had an appreciably elevated testosterone level, which was not suppressed by dexamethasone, but was increased by stimulation with human chorionic gonadotropin (hCG). Ultrasonography and computed tomography revealed an adenoma 2.5-3.0 cm in diameter in the right adrenal gland. The patient was treated with the antiandrogen flutamide in a daily dose of 500 mg for 4 months. A substantial regression of her hirsutism was observed during flutamide administration, but the serum testosterone level remained high. Right adrenalectomy was performed. Histologically, the tumor proved to be an adrenocortical adenoma of zona reticularis type. The adenoma tissue contained specific hCG receptors (187 fmol/g). The steroid concentration in the tumor tissue was examined by means of high pressure liquid chromatography-radioimmunoassay (HPLC-RIA). A significantly increased testosterone content was detected, and the levels of its precursors, androstenedione and dehydroepiandrosterone, were also elevated. Following adrenalectomy, serum testosterone concentration decreased to the normal level. The mechanism of the inappropriate regulation in the testosterone production of the adrenal tumor has not been fully elucidated.

Testosterone-secreting virilizing adrenal adenoma with human chorionic gonadotrophin receptors and 21-hydroxylase deficiency

A 60-year-old woman was evaluated for persistently elevated serum testosterone concentrations after bilateral ovariectomy. Her serum cortisol, androstenedione, dehydroepiandrosterone sulphate and 17-hydroxyprogesterone levels were normal, and decreased after dexamethasone administration. Those of testosterone (17.8-18.4 nmol/l) were remarkably high (normal range 0.7-2.8 nmol/l), were not suppressed by dexamethasone, but clearly increased after hCG administration (up to 128 nmol/l). Computed tomography revealed an adenoma in the right adrenal gland and adrenal scintigraphy under dexamethasone suppression visualized this adenoma. A right adrenalectomy was performed. (1) The tumour was histologically and ultrastructurally adrenocortical adenoma of zona reticularis cell type. (2) The adenoma tissue contained hCG receptors (198 fmol/g). (3) During tissue culture both ACTH and hCG were capable of maintaining its testosterone production, which was attenuated with time without stimulation. (4) The adenoma tissue did not elaborate 21-hydroxylated steroids in contrast to normal adrenal tissue. Thus the aberrant endocrine behaviour of this gonadotrophin-responsive testosterone-secreting adenoma of adrenal zona reticularis cell origin can be explained by ectopic functional hCG receptors and the lack of 21-hydroxylase activity.

Gonadotropin-releasing hormone agonist analog therapy effective in ovarian granulosa cell malignancy

Ovarian granulosa cell tumor lung metastases regressed, and symptoms were relieved, during gonadotropin-releasing hormone (GnRH) agonist analog therapy after the failure of operative treatment and cytotoxic chemotherapy, indicating the hormone dependence of the malignancy. The response was transient, but the largest metastasis did not relapse. This case report suggests that GnRH analogs may offer a new approach to the treatment of ovarian stromal cell malignancies.

Ovarian and peripheral steroid hormones in a case of Sertoli-Leydig cell tumor

The clinical course, histology, and steroid secretion of a 59-year-old postmenopausal woman with a 4-yr history of virilizing well-differentiated Sertoli-Leydig cell tumor of the right ovary are reported. Hormone secretion was examined by measuring peripheral and ovarian venous gradients and pre-and postoperative levels of some delta 4 and delta 5 steroids, estrogens, gonadotropins and Sex Hormone Binding Globulin levels. The preoperative responsiveness to ACTH, dexamethasone and hCG is also reported. The results are consistent with a Sertoli-Leydig cell tumor producing mainly testosterone and, to a lesser degree, androstenedione, progesterone, estrone and 17 alpha-hydroxyprogesterone. The tumor hormone secretion may be in part responsive to hCG.