Ovaryen venlerin selektif kateterizasyonu ile tanı alan bir postmenapozal ovaryen hiperandrojenemi vakası

Öz

Postmenapozal dönemde hiperandrojenemi genellikle over veya adrenal bezlerdeki tümörlerle ilişkilidir. Her iki endokrin organdaki tümörlerin çapları çok küçük olduğunda görüntüleme yöntemleri tanıda yetersiz kalmaktadır. 54 yaşında postmenapozal hasta, klitoromegali ve artış gösteren hirsutizm bulguları olan hasta serum total testosteron seviyesi 294 ng/dl ile bölümümüze başvurdu. Kontrastlı bilgisayarlı tomografide (BT) adrenal bezde 1 cm çapında tümör ile uyumlu lezyon saptandı ancak manyetik rezonans (MR) ile bu bulgu teyit edilemedi. Androjen hipersekresyonunun orijininin tespit edilememesi üzerine bilateral ovaryen ve adrenal venlerin selektif venöz kateterizasyonu ve hormonal örneklemesi yapıldı. Sağ ovaryan ven total testosteron düzeyi >1009,40 ng/dl olarak bulundu. Laparoskopik histerektomi ve bilateral salpingooferektomi yapılan hastanın patoloji sonucu sağ over kaynaklı Leydin Hücreli Tümör olarak geldi. 

Bu olgu sunumunda, postmenopozal bir kadında androjen hipersekresyonu kaynağını bulunamadığında , hem ovaryen venden hem de adrenal venlerden selektif venöz kateterizasyon ve hormonal örnekleme yapmanın önemi vurgulanmaktadır.

Anahtar Kelimeler

• Postmenopoz,Hiperandrojenizm,Yumurtalık Neoplazmaları,Leydig hücreli tümör,Selektif venöz kateterizasyon

A case of postmenopausal ovarian hyperandrogenemia diagnosed only by selective catheterization of ovarian vein

Abstract

Hyperandrogenemia in a postmenopausal woman is usually related to a tumor in either ovaries or adrenal glands. To differentiate between these two endocrine organs is a diagnostic challenge when the tumor size is too small to be detected with the aid of usual imaging modalities. 54 years-old postmenopausal woman with signs of virilization was referred to our institution with serum total testosteron levels of 294 ng/dl. Contrast-enhanced computed tomography (CT) revealed a lesion consistent with the tumor 1 cm in diameter in the adrenal gland and magnetic resonance imaging (MRI) could not confirm this finding. The location of androgen hypersecretion could only be determined after selective venous catheterization and hormonal sampling of both adrenal and ovarian veins. The right ovarian venous total testosterone level was found as > 1009.40 ng / dl. A right-sided ovarian Leydig cell tumor was diagnosed in the specimen of laparoscopic hysterectomy and bilateral salpingo-oopherectomy. This case report underlines the importance to carry on the search with the selective venous catheterisation and hormonal sampling from both the ovarian and the adrenal veins when there is difficulty to demonstrate the true source of androgen hypersecretion in a postmenopausal woman. 

Keywords

• Postmenopause,Ovarian Neoplasms,Hyperandrogenism,Leydig cell tumor,Selective venous catheterization

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