Acta Clinica Belgica International Journal of Clinical and Laboratory Medicine
ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://www.tandfonline.com/loi/yacb20
Association of Androgen-Producing Ovarian Tumour and Acromegaly J. Donckier, B. Picron, M. Smets, C. Gilliard & M. Buysschaert To cite this article: J. Donckier, B. Picron, M. Smets, C. Gilliard & M. Buysschaert (1992) Association of Androgen-Producing Ovarian Tumour and Acromegaly, Acta Clinica Belgica, 47:6, 429-430, DOI: 10.1080/17843286.1992.11718266 To link to this article: http://dx.doi.org/10.1080/17843286.1992.11718266
Published online: 16 May 2016.
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Date: 09 August 2017, At: 06:11
429
Downloaded by [Australian Catholic University] at 06:11 09 August 2017
ASSOCIATION OF ANDROGEN-PRODUCING OVARIAN TUMOURANDACROMEGALY
Sir,
An increase in coarse hair causing hirsuti sm is 1 we ll recog ni zed in acromegaly but is not assoc iated with masc ulini zation. Nevertheless, true hypera ndrogeni sm has been inc identa ll y 1 observed and attributed to ad renal androgenic hyperfunctio n (I), ovari an stromal hyperthecos is , or pol ycysti c ovaries (2).
I
We report the case of a 63-year-old woman , referred for hirsuti sm. She had a past hi story of hypertension and carpa l tunn el syndrome. Six , months before adm iss ion, he ex pe ri enced a generali zed increase in hair growth , a deepen in g voice and an enl argement offeet. On examinati on, • she was androgeni zed and had sli ght facia l acromegalic features. A multi nodul ar goiter was palpated. Total and free plasma testosterone were ~ respecti vel y 13.7 nmol/I (normal < 2.4) and 156 pmol/1 (normal < 30). Plas ma androstenedione and 17-0 H progesterone were increased up to 33 nmol/I (normal 7 ± 2) and 13 nmol/I (norma l < 5). Pl asma dehydroepiandros tero ne sul fate and cortisol were normal. High gonadotropin levels r were cons istent wi th menopause. During a 5-day dexamethasone (2 mg/day) suppress ion test, co rti so l was s uppresse d b ut tes tos te rone , andros te ne dion e a nd 17-0 H proges te ro ne remained elevated. 17-0 H progesterone was not stimul ated by a short ACTH (Synacthen 250 µ g) test. Besides thi s hyperandrogenism, acromegaly was diagnosed o n the bas is of an inc reased somatomedin-C level (4.8 U/ml; normal < 2) and a paradoxal ri se of g rowth hormone (GH) durin g a glucose tol erance test and a TRH -test (up to 5.9 and 16.4 ng/ml respecti vely). Prol actine and
l
I
, f
thyroid hormones were normal. Basa l plas ma TSH was 0.3 µU/ml (norma l 0. 3 - 5) and did not respond to the TRH -test. A computeri zed axial tomography (CAT) scanning of adrenals and ovaries was normal. A pe lvic laparoscopy di sc losed an irregular surface on the left ovary. Both ovaries were re moved. l n the right ovary, mi croscopi c exa min ation revea led a steroidsecretin g tumour which was not typical of a Ley di g ce ll tumour because of the absence of crystals of Reinke. A nucl ear magnetic resonance of the pituitary g land ho wed a small tumour w hi c h was s ub sequently re mov e d by tra ns ph e no id a l se lec tiv e adeno-mectomy. Hi stologically, th e tumour was an ac idophil ade no ma, fo und (after immunostaining) to secrete GH andTSH. Testosterone, 17-0H proge terone and so matomed in -C are now norma li zed and hirsuti sm has regressed substanti all y. In conclu sion, we report the first case to our knowl edge assoc iating a pituitary GH -and TSH secretin g tum our and an ova ri an androgensecreting tumour. The role of growth hormone as a causati ve link in tumourigenesis is c urrently well estab li shed and experi mental studi es have shown occ urrence of so lid ovarian tumours after GH inj ection (3). It is noticeable that secretion of the pituitary tumour was pluripotential. However, if acromega ly was present, the pati ent was clinically euth yro id . Thi s case leads us to stress that ac romegali c patients with hypera ndrogeni sm may be at ri sk for hav ing an ova rian androgen-sec retin g tumo ur. A 5 - to 7-day dexam ethaso ne suppress ion te t is then he lpful in identifyi ng such a tumour. Acta Clinica Belgica 47.6 ( 1992)
ASS OC /A TION OF ANDROGEN-PRODUC ING OVA RIAN TUMOUR AND A CROMEGALY
430
REF R NCES:
Downloaded by [Australian Catholic University] at 06:11 09 August 2017
I. Ehnnann DA , Ro enfield RL. An endocrinologic approach to the patient with hirsutism. J Clin Endocrinol Metab. 1990; 71 : I - 4 2. Randall RV . Acr rnegaly and giganti sm. In De Groot L.J . ed. -ndocrinology. Phil adelphi a:
Saunders, 1989; 337. 3. Ezzat S, Melmed S. Are patients with ac rornegaly al increased ri k for neoplasia? J C/i11 Endocrinl)/ Metab. 1991 ; 72: 245-9.
J Donckier, B. Picron, M. Srnets, C. Gilliard and M. Buyssc haert liniques Uni versi1 aires de Mont-Godinne B-5530 Yvoir - BELGIUM
l
I
~'
l
1
1
1 Acta
li11i ·a Belgica 47. 6 ( 1992)
ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://www.tandfonline.com/loi/yacb20
Association of Androgen-Producing Ovarian Tumour and Acromegaly J. Donckier, B. Picron, M. Smets, C. Gilliard & M. Buysschaert To cite this article: J. Donckier, B. Picron, M. Smets, C. Gilliard & M. Buysschaert (1992) Association of Androgen-Producing Ovarian Tumour and Acromegaly, Acta Clinica Belgica, 47:6, 429-430, DOI: 10.1080/17843286.1992.11718266 To link to this article: http://dx.doi.org/10.1080/17843286.1992.11718266
Published online: 16 May 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yacb20 Download by: [Australian Catholic University]
Date: 09 August 2017, At: 06:11
429
Downloaded by [Australian Catholic University] at 06:11 09 August 2017
ASSOCIATION OF ANDROGEN-PRODUCING OVARIAN TUMOURANDACROMEGALY
Sir,
An increase in coarse hair causing hirsuti sm is 1 we ll recog ni zed in acromegaly but is not assoc iated with masc ulini zation. Nevertheless, true hypera ndrogeni sm has been inc identa ll y 1 observed and attributed to ad renal androgenic hyperfunctio n (I), ovari an stromal hyperthecos is , or pol ycysti c ovaries (2).
I
We report the case of a 63-year-old woman , referred for hirsuti sm. She had a past hi story of hypertension and carpa l tunn el syndrome. Six , months before adm iss ion, he ex pe ri enced a generali zed increase in hair growth , a deepen in g voice and an enl argement offeet. On examinati on, • she was androgeni zed and had sli ght facia l acromegalic features. A multi nodul ar goiter was palpated. Total and free plasma testosterone were ~ respecti vel y 13.7 nmol/I (normal < 2.4) and 156 pmol/1 (normal < 30). Plas ma androstenedione and 17-0 H progesterone were increased up to 33 nmol/I (normal 7 ± 2) and 13 nmol/I (norma l < 5). Pl asma dehydroepiandros tero ne sul fate and cortisol were normal. High gonadotropin levels r were cons istent wi th menopause. During a 5-day dexamethasone (2 mg/day) suppress ion test, co rti so l was s uppresse d b ut tes tos te rone , andros te ne dion e a nd 17-0 H proges te ro ne remained elevated. 17-0 H progesterone was not stimul ated by a short ACTH (Synacthen 250 µ g) test. Besides thi s hyperandrogenism, acromegaly was diagnosed o n the bas is of an inc reased somatomedin-C level (4.8 U/ml; normal < 2) and a paradoxal ri se of g rowth hormone (GH) durin g a glucose tol erance test and a TRH -test (up to 5.9 and 16.4 ng/ml respecti vely). Prol actine and
l
I
, f
thyroid hormones were normal. Basa l plas ma TSH was 0.3 µU/ml (norma l 0. 3 - 5) and did not respond to the TRH -test. A computeri zed axial tomography (CAT) scanning of adrenals and ovaries was normal. A pe lvic laparoscopy di sc losed an irregular surface on the left ovary. Both ovaries were re moved. l n the right ovary, mi croscopi c exa min ation revea led a steroidsecretin g tumour which was not typical of a Ley di g ce ll tumour because of the absence of crystals of Reinke. A nucl ear magnetic resonance of the pituitary g land ho wed a small tumour w hi c h was s ub sequently re mov e d by tra ns ph e no id a l se lec tiv e adeno-mectomy. Hi stologically, th e tumour was an ac idophil ade no ma, fo und (after immunostaining) to secrete GH andTSH. Testosterone, 17-0H proge terone and so matomed in -C are now norma li zed and hirsuti sm has regressed substanti all y. In conclu sion, we report the first case to our knowl edge assoc iating a pituitary GH -and TSH secretin g tum our and an ova ri an androgensecreting tumour. The role of growth hormone as a causati ve link in tumourigenesis is c urrently well estab li shed and experi mental studi es have shown occ urrence of so lid ovarian tumours after GH inj ection (3). It is noticeable that secretion of the pituitary tumour was pluripotential. However, if acromega ly was present, the pati ent was clinically euth yro id . Thi s case leads us to stress that ac romegali c patients with hypera ndrogeni sm may be at ri sk for hav ing an ova rian androgen-sec retin g tumo ur. A 5 - to 7-day dexam ethaso ne suppress ion te t is then he lpful in identifyi ng such a tumour. Acta Clinica Belgica 47.6 ( 1992)
ASS OC /A TION OF ANDROGEN-PRODUC ING OVA RIAN TUMOUR AND A CROMEGALY
430
REF R NCES:
Downloaded by [Australian Catholic University] at 06:11 09 August 2017
I. Ehnnann DA , Ro enfield RL. An endocrinologic approach to the patient with hirsutism. J Clin Endocrinol Metab. 1990; 71 : I - 4 2. Randall RV . Acr rnegaly and giganti sm. In De Groot L.J . ed. -ndocrinology. Phil adelphi a:
Saunders, 1989; 337. 3. Ezzat S, Melmed S. Are patients with ac rornegaly al increased ri k for neoplasia? J C/i11 Endocrinl)/ Metab. 1991 ; 72: 245-9.
J Donckier, B. Picron, M. Srnets, C. Gilliard and M. Buyssc haert liniques Uni versi1 aires de Mont-Godinne B-5530 Yvoir - BELGIUM
l
I
~'
l
1
1
1 Acta
li11i ·a Belgica 47. 6 ( 1992)
