Virilization, Ovarian Hyperthecosis and Torsion Masquerading as Malignancy: A Case Report.
Overview
abstract
BACKGROUND: Premenopausal females with signs of androgen excess and oligomenorrhea are commonly evaluated for polycystic ovarian syndrome (PCOS) or for an androgen-secreting tumor if a pelvic mass is present. Ovarian hyperthecosis (OHT) as a cause of these symptoms in adolescents is rare. CASE: A 15-year-old female with primary amenorrhea and signs of virilization was referred to Pediatric and Adolescent Gynecology after pelvic imaging demonstrated a pelvic mass, suspected to be arising from the right ovary, and an adjacent paratubal cyst. Preoperative laboratory evaluation revealed markedly elevated testosterone levels [free testosterone 81.5 pg/mL (normal < 7.5 pg/mL); total testosterone 279.6 ng/mL (normal < 52.0 ng/mL)]. Ovarian tumor markers were otherwise normal. Surgical evaluation revealed bilaterally enlarged ovaries and right paratubal cyst with right ovarian torsion. Rather than demonstrating an androgen-secreting tumor, pathologic evaluation following right salpingo-oophorectomy resulted in an unexpected diagnosis of OHT. SUMMARY AND CONCLUSION: Our case demonstrates that OHT should be considered in the differential in the setting of a large pelvic mass and virilization in an adolescent.
