Presentation
Abstract A 53-year-old woman presented with hirsutism of long duration and virilization of recent onset. She was gravida 12 para 9. [ncbi.nlm.nih.gov]
A 70-year-old nulliparous woman presented with gradual onset of hyperandrogenism (Ferriman-Gallwey [FG] score 20) for 10 years [Figure 1] and [Figure 2]. [jmidlifehealth.org]
In this article, we present the first published cases of the magnetic resonance imaging appearance of these conditions, which may mimic that of ovarian neoplasm. [dx.doi.org]
Clinical presentation in conjunction with the imaging findings lead to a correct diagnosis in the vast majority of women presenting with hyperandrogenism. [redorbit.com]
Skin
- Hirsutism
CASE: A postmenopausal woman sought treatment for progressive hirsutism. Endocrine evaluation revealed androgen excess. Transvaginal ultrasound revealed enlarged ovaries. Hysterectomy and bilateral oophorectomy were recommended. [jhu.pure.elsevier.com]
Aquino, A simplified questionnaire for self-assessment of hirsutism in population-based studies, European Journal of Endocrinology, 172, 4, (451), (2015). [doi.org]
Abstract A 53-year-old woman presented with hirsutism of long duration and virilization of recent onset. She was gravida 12 para 9. [ncbi.nlm.nih.gov]
A score of 8 to 15 is classified as mild hirsutism, while moderate hirsutism is a score greater than 15. This patient had severe hirsutism with virilizing signs. Therefore, it was not necessary to grade her level of hirsutism. [arcfertility.com]
Cyclosporin should be changed to tacrolimus when hirsutism occurs. Virilisation (development of male characteristics in women) occurs in less than 1% of patients with hirsutism. [hkmj.org]
- No Pubic Hair
Examination of the external genitalia showed normal pubic hair distribution and clitoral enlargement (1.5 cm x 2.5 cm). Further gynecologic examination was otherwise normal. The rest of the physical examination was unremarkable (Figures 1A to C). [asean-endocrinejournal.org]
In prepuberal girls it can cause isosexual precocity [ 13, 14 ], with hirsutism, acne, growth- acceleration, clitoral enlargement and pubic hair. Laryngeal hypertrophy and deepening of the voice has also been described [ 2 ]. [omicsonline.org]
Urogenital
- Adnexal Mass
A transvaginal ultrasound revealed bilateral solid adnexal masses, likely to be ovarian in nature, although no normal ovarian tissue was identified. [endocrine-abstracts.org]
Transvaginal ultrasound showed a normal uterus with endometrial thickness of 5 mm and no adnexal masses. Figure 1. Facial features of the patient with frontal balding and prominent facial hair requiring regular shaving Questions: 1. [hkmj.org]
Nonetheless, a small painless mobile firm and solid left adnexal mass was detected in the bimanual pelvic examination. Pelvic sonography also showed enlarged left ovary (40 mm × 21 mm) without visible mass. [mjdrdypu.org]
Local genital examination showed mild clitoromegaly; per speculum examination showed healthy cervix and vagina; on bimanual examination the uterus was normal in size with no palpable adnexal mass. [jpgo.org]
Doppler examination of the left adnexal mass showed rich intratumoral vascularity on color flow mapping with high resistance wave pattern, suggestive of a benign nature (B). Click here to download Figure 4 Figure 4. [asean-endocrinejournal.org]
- Ovarian Disorder
Young and Scully´s 1979 classification of ovarian tumors with endocrine manifestations ( Figure 1 ) includes sex-cord stromal tumors, steroid-cell tumors and other ovarian disorders with endocrine function. [omicsonline.org]
Workup
Further workup with transvaginal ultrasonography showed a thickened, hyperechoic endometrium (0.72 cm) at the upper half of the uterus, with minimal intracavitary fluid. The lower endometrium measured 0.37cm. [asean-endocrinejournal.org]
Ultrasound
- Ovarian Mass
At initial MR imaging, the central areas of the bilateral ovarian masses showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images, while the peripheries of the bilateral masses showed isointensity to myometrium on T1-weighted [ncbi.nlm.nih.gov]
Here, we report a case of a 55-year-old woman who referred to our center due to incidental finding of left ovarian mass in pelvic sonography. [mjdrdypu.org]
CT of the abdomen and pelvis did not show an adrenal or ovarian mass. [healio.com]
Hysterectomy with removal of both ovaries was discussed with the patient because of the presence of bilateral ovarian masses, which required diagnosis and treatment. [arcfertility.com]
Most ovarian hemangiomas are of the cavernous type and they may present either as an isolated ovarian mass, usually discovered incidentally, or in conjunction with diffuse abdominopelvic hemangiomatosis 1 - 3. [turkjpath.org]
Treatment
3 months of treatment. c After 13 months of treatment. d After 8 months of treatment. [dx.doi.org]
Make the best clinical decisions with an enhanced emphasis on evidence-based practice and expert opinions on treatment strategies. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography. [books.google.com]
CASE: A postmenopausal woman sought treatment for progressive hirsutism. Endocrine evaluation revealed androgen excess. Transvaginal ultrasound revealed enlarged ovaries. Hysterectomy and bilateral oophorectomy were recommended. [jhu.pure.elsevier.com]
[…] for the treatment of hirsutism in PCOS. [what-when-how.com]
Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society. J Clin Endocrinol Metab 2018; 103 (4): 1233-57. doi: 10.1210/jc.2018-00241 [ Links ] 21. Cobin RH1, Futterweit W, Ginzburg SB, Goodman NF et al. [scielo.org.mx]
Prognosis
The prognosis is similar to that of the latter tumor. [glowm.com]
Treatment and prognosis postmenopausal women: bilateral oophorectomy is suggested; however, if the patient has multiple comorbidities, then long-term GnRH agonist treatment may be an option when malignancy has been excluded premenopausal women: treatment [radiopaedia.org]
TTF-1 meningioma: may be microcystic but also shows whorls: positive for EMA Brenner tumour with microcystic change Surface epithelial carcinomas with microcystic change Ovarian adenomatoid tumour: positive for calretinin and inhibin Myxoid sarcoma Prognosis [e-immunohistochemistry.info]
Women with hyperthecosis have a significant degree of insulin resistance and insulin may stimulate the ovarian stromal androgen synthesis.[8] Prognosis[edit] Although no large studies showing the long term outcomes for women with hyperthecosis exist, [en.wikipedia.org]
Etiology
Definition / general Hyperplastic ovarian stroma with clusters of luteinized stromal cells Epidemiology Typically seen in the 6th to 7th decade, less common in reproductive age Etiology Luteinized stromal cells produce androgens Clinical features Similar [pathologyoutlines.com]
There are multiple etiologies, and each etiology might also be complicated by the medical condition of insulin resistance which also tends to have some relationship to the liver "fatty liver" condition, NASH. [palpath.com]
(605) 328-8800 Abstract Hirsutism is a common problem affecting women that is usually the result of a benign etiology. [arcfertility.com]
Women with hyperthecosis may or may not have always had underlying PCOS.[6] Cause[edit] The etiology of hyperthecosis is unknown, however evidence suggests a possibility of genetic transmission. [en.wikipedia.org]
Given the etiological role of insulin resistance and the impact of obesity on both hyperinsulinemia and hyperandrogenism, multidisciplinary lifestyle improvement aimed at normalizing insulin resistance, improving androgen status and aiding weight management [medigoo.com]
Epidemiology
Definition / general Hyperplastic ovarian stroma with clusters of luteinized stromal cells Epidemiology Typically seen in the 6th to 7th decade, less common in reproductive age Etiology Luteinized stromal cells produce androgens Clinical features Similar [pathologyoutlines.com]
Epidemiology, diagnosis and management of hirsutism: A consensus statement by the androgen excess and polycystic ovary syndrome society. Hum Reprod Update 2012; 18 (2): 146-70. doi:10.1093/humupd/dmr042 [ Links ] 10. Robert E. Scully, Robert H. [scielo.org.mx]
Epidemiology, diagnosis and management of hirsutism: A consensus statement by the androgen excess and polycystic ovary syndrome society. Hum Reprod Update 2012; 18 (2): 146-70. doi:10.1093/humupd/dmr042 Robert E. Scully, Robert H. [medigraphic.com]
One epidemiologic study that included a 30-year follow-up of women with PCOS found no increase in mortality from cardiovascular disease.66 [what-when-how.com]
J Clin Endocrinol Metab 2004, 89: 2745–49. 10.1210/jc.2003-032046 View Article PubMed Google Scholar Hull MG: Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies. [ovarianresearch.biomedcentral.com]
Pathophysiology
Pathophysiology of ovarian hyperthecosis remains poorly understood but the metabolic syndrome observed in most patients suggests that insulin resistance associated with high, postmenopausal LH levels, might play a role as in polycystic ovarian syndrome [ncbi.nlm.nih.gov]
Although the exact pathophysiology is not known, disturbances in gonadotropins and reduced insulin sensitivity are known to contribute to the overproduction of androgens. [har-journal.com]
Furuya M (2012) Ovarian cancer stroma: pathophysiology and the roles in cancer development. Cancers (Basel) 4: 701-724. Roth LM, Talerman A (2006) Recent advances in the pathology and classification of ovarian germ cell tumors. [omicsonline.org]
Even though ovarian stromal hypertrophy is largely involved in the pathophysiology of PCOS [ 6 ] and it could be properly identified by vaginal endosonography [ 9 ], the acceptance of ultrasound ovarian stromal hypertrophy as a additional criterion for [ovarianresearch.biomedcentral.com]
Prevention
Multivitamins prevent multiple birth defects such as heart and limb defects, neural tube defects, urinary tract anomalies and oral facial clefts. [bionova.co.in]
PC has since, gained widespread acceptance as a method of choice for preventing OHSS and has established itself as the “standard of care”. [drgeoffreysherivf.com]
The addition of an oral contraceptive prevents GnRH agonist-induced hypoestrogenism and vasomotor symptoms and preserves bone density. [what-when-how.com]
Preventative measures for PCOD are limited. Clinical management is primarily focused on treating symptoms and manifestations and preventing long-term complications. [har-journal.com]
Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: A consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. [asean-endocrinejournal.org]