••• Chapter 58^ Hyperandrogenism^579
❍ What is the typical age Sertoli-Leydig tumors are seen?
Age 25 with the vast majority being benign.
❍ Virilization occurring in pregnancy should raise suspicion for?
The presence of a luteoma that is an exaggerated reaction of the ovarian stroma to human chorionic gonadotropin
(hCG). Hyperreactio luteinalis (functional androgen-producing theca-lutein cysts), also a nonneoplastic condition
resulting in bilateral ovarian enlargement, is more commonly seen in conditions of high hCG such as multiple
gestations, fetal hydrops, hydatidiform mole, and gestational trophoblastic disease.
❍ What are the typical findings seen in stromal hyperthecosis?
It is similar to PCOS but typically more severe and long standing. Serum testosterone is typically >200 ng/dL,
both ovaries are enlarged, and the ovary rarely responds to stimulation or suppression.
❍ What is the histologic appearance of hyperthecosis?
Patches of luteinized theca-like cells scattered throughout ovarian stroma. This results in more intense
androgenization and a greater degree of insulin resistance.
❍ An ovarian or adrenal androgen-secreting tumor should be suspected when?
Suspect clinically by history and physical examination, sudden as opposed to gradual onset of symptoms;
virilization, ovarian tumors tend to be unilateral with testosterone levels >150 ng/dL, adrenal tumors typically have
DHEA-S levels > 700 μg/dL.
❍ What percentage of DHEA is produced by the testes or ovaries?
About 20%.
❍ In men compared with women, what is the percentage of testosterone derived from the adrenals or adrenal
precursors?
Less than 5% in men compared to 40% to 65% in women depending on the menstrual phase of the cycle.
❍ What are some of the causes of adrenal hyperandrogenism?
Primary ADRENAL: Premature adrenarche; adrenal tumors, androgen-secreting carcinomas
Adrenocorticotropic hormone (ACTH)-dependent causes: Congenital adrenal hyperplasia (CAH)
(21-hydroxylase deficiency and 11b-hydroxylase deficiency), ACTH-dependent Cushing syndrome,
glucocorticoid resistance.
Other causes: Hyperprolactinemia and placental enzyme deficiencies (deficient in placental aromatase or
sulfatase).
❍ Name characteristics of an adrenal mass that are typical for an adenoma and for a carcinoma.
Adenomas are small, usually <4 cm in diameter, have smooth borders and low unenhanced CT attenuation values.
Carcinomas are larger, and have irregular margins, necrosis, hemorrhage, or calcifications.
❍ How can hyperprolactinemia cause hyperandrogenism?
Prolactin receptors have been identified in the human adrenal and prolactin can increase adrenal DHEA
production.