Virilization degree and FSH level discriminate better between post menopausal women with virilizing ovarian tumor (VOT) and ovarian hyperthecosis (OH) than testosterone levels

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 498-523-Female Reproductive Endocrinology & Case Reports
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-523
Viviane dos Reis Vieira Yance*1, Jose Antonio Marcondes2, Cristiano Roberto Barcellos3, Michelle P Rocha4, Sorahia Domenice5 and Edmund C. Baracat6
1Hospital das Clinicas de Sao Paulo, Sao Paulo, Brazil, 2Hosp das Clinicas de Sao Paulo, Professor Sperber, Brazil, 3Hospital das Clinicas de Sao Paulo, Sao Paolo, Brazil, 4Univ of Sao Paulo Med Schl, Sao Paulo, Brazil, 5Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 6Hospital das Clinicas de Sao Paulo, Professor Sperber, Brazil
Virilization in post-menopausal women are rare, and the differentiation between VOT and OH, the two main causes, is difficult, as images studies are usually misleading. We studied 7 women with VOT and 7 with OH (age: 59.7±8.0 x 61.4±8.2 yo, p=0.1356, BMI: 32.2±9.4 x 29.4±4.6 kg/m2, p=0.592). All were hirsute and in all the diagnosis was histologic proven. Years post-menopause until to the diagnosis were 10.1±9.5 years for VOT and 5.8±3.9 years for OH (p=0.25). In women with VOT, ovarian volume on ultrasound was not visualized in 1 and slight unilateral enlarged in the others 6, while in the OH woman ovarian volume on was not visualized in 1, normal size in 1, unilateral enlarged in 2 and bilateral enlarged in 3.

All women had at least 1 sign of virilization. Its presence was much more common in women with VOT than in women with OH (alopecia: VOT: 7 of 7 x HO: 4 of 7; clitoromegaly: VOT: 6 of 7 x OH: 1 of 7; deepening of the voice: VOT: 7 of 7 x OH: 1 of 7 and increase muscle mass: VOT: 7 of 7 x HO: 1 of 6). A virilization index (one point for each symptoms and signs) was higher in VOT (3.7±0.7) than in OH (0.8±0.4) (p<0.001).

Testosterone (RIA, median of 2 values) was higher in VOT (516.7±270.2 ng/dL) than in OH (179.5±102.8 ng/dL) (p<0.001), but with overlap between both groups (minimal and maximal values – VOT:184 and 1,114 ng/mL; OH:103 and 503 ng/mL); 4 women with OH has a higher testosterone level higher than the minimal value observed in VOT (185 to 245 ng/mL x 184 ng/dL). DHEAS, D4, 17OPH and LH were not different between the groups (p>0.01), but FSH was significantly lower in VOT (9.8±8.7 IU/L) than in OH (42.1± 17.5 IU/L) (p=0.001). Only 1 woman in the OH group presented a concentration of FSH lower than 33 IU/L (10.5 IU/L), whereas the highest concentration of FSH observed in group VOT  group was 23.4 IU/L.

Nothing to Disclose: VDRVY, JAM, CRB, MPR, SD, ECB

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