July - September 2015, Volume 11, Issue 3

Ghervan CM, Nemes C, Muresan D, Crisan D, Ghervan L

Secreting Ovarian Leydig Cell Tumor with Complex Clinical Features: Virilizing Syndrome, Polyglobulia, Hypertension, Dyslipidemia and Uterine Fibromatosis

Acta Endo (Buc) 2015, 11 (3): 381-388
doi: 10.4183/aeb.2015.381

Background. Virilizing syndrome in a postmenopausal woman is a concerning matter, raising the suspicion of androgen-secreting tumour. Case report. A 65 years old woman presented with severe virilization features evolving rapidly over 4 years, accompanied by: severe polyglobulia, severe hypertension, dyslipidemia and uterine fibromatosis compressing both ureters, producing first degree hydroureteronephrosis. The hormonal dosages showed very high levels of both testosterone (15.5 ng/mL) and estradiol (299 pg/mL), meanwhile DHEAS level was normal, indicating an ovarian pathological secretion. The endovaginal ultrasound and computed tomography scan revealed an enlarged right ovary of 5.5/2.8 cm. A total hysterectomy and bilateral oophorectomy was performed. Pathological examination confirmed the diagnosis of right ovarian hilum Leydig cell tumour. After surgery, the testosterone and estradiol levels normalized (concordant to the age and menopausal status), the virilizing syndrome progressively improved and polyglobulia, hypertension and dyslipidemia remitted showing their secondary etiology. Conclusion. We present a very rare case of secreting ovarian Leydig cell tumour in a postmenopausal woman, showing besides the virilizing syndrome, four unusual features: severe polyglobulia, due to androgen excess, severe hypertension and dyslipidemia, all remitted after tumour removal, and severe compressive uterine fibromatosis that was the consequence of the estrogen excess.

Keywords: ovarian Leydig cell tumour, polyglobulia, virilizing syndrome, secondary hypertension

Correspondence: Cristina Mariana Valeria Ghervan MD, University of Medicine and Pharmacy, Endocrinology, 3 Pasteur street, Cluj-Napoca, Cluj, 400349, Romania, E-mail: cghervan@yahoo.com