Impact of clinical, hormonal, radiological, and immunohistochemical studies on the diagnosis of postmenopausal hyperandrogenism

摘要

Postmenopausal biochemical hyperandrogenism occurs rarely. The presence of an underlying tumor in women with this condition may be missed without careful evaluation.- Androgen excess in these women is the result of either tumoral or nontumoral causes. Factors that distinguish between tumoral and nontumoral etiology have not been identified.The primary goal of this retrospective study was to identify specific characteristics that could help differentiate between tumoral or nontumoral etiology among postmenopausal women suspected of having an androgen-secreting tumor. Participants were 22 postmenopausal women with biochemical hyperandrogenism referred to a medical center between 1995 and 2009. Clinical, biological, and morphological evaluations were performed in all women. Surgical resection of both ovaries was most often proposed for women without adrenal tumors, and immunocytochemical studies of the ovaries were performed.Among the 22 participants, 8 cases of ovarian tumors were identified based on ultrasound and/or magnetic resonance imaging. Two additional cases had an adrenal tumor diagnosed by computed tomography. The remaining 12 women had various nontumoral conditions. The clinical presentation in women with and without tumors was very similar. Some differences between the 2 groups, however, were found in the biological phenotype. Compared with women without tumors, women with tumors had significantly higher levels of testosterone [2.6 (2.7) vs 0.9 (0.9) ng/mL, P < 0.05] and lower levels of basal follicle-stimulating hormone [FSH; 26.5 (22.9) vs 66.5 (26.0) IU/L, P < 0.01] and luteinizing hormone [12.0 (8.6) vs 24.1 (8.9) IU/L, P < 0.05]. Based on the likelihood ratio, the risk of having a testosterone level of 1.4 ng/mL or greater or an FSH level of 35 IU/L or less in postmenopausal women with a tumor was 8.4 and 10.8 times higher, respectively. Immunochemistry using P450cl7alpha antibody allowed identification of an elevated number of ovarian androgen-producing cells in 5 patients with tumors undetectable by conventional histology.These findings show no differences in clinical phenotype that can be used to discriminate between androgen-secreting tumors and other nontumoral causes of postmenopausal hyperandrogenism. The data suggest that 2 hormonal phenotypes, testosterone and basal FSH levels, may be discriminating markers.