The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 3 738-739
Copyright © 2006 by The Endocrine Society
Testosterone-Secreting Ovarian Tumor Localized with (Fluorine-18)-2-Deoxyglucose Positron Emission Tomography
Cecilia Mattsson,
C. Robert Stanhope,
Susan Sam and
William F. Young, Jr.
Department of Public Health and Clinical Medicine, Umeå University Hospital (C.M.), S-901 85 Umeå, Sweden; Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University (S.S.), Chicago, Illinois 60611-3008; and Department of Obstetrics and Gynecology (C.R.S.) and Division of Endocrinology, Diabetes, Metabolism, and Nutrition (W.F.Y.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
Address all correspondence and requests for reprints to: Dr. William F. Young, Jr., Mayo Clinic College of Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. E-mail: young.william{at}mayo.edu.
A 25-yr-old woman presented with secondary amenorrhea, progressive hirsutism, clitoromegaly, and increased muscle mass. Serum total testosterone (T-tot) and androstenedione concentrations were elevated. Computed tomography (CT) showed micronodular adrenals. Ovarian ultrasound (US) showed prominent-sized ovaries, but no mass. The patient was referred to the Mayo Clinic (Rochester, MN) for additional evaluation. Physical examination showed marked hirsutism involving the face and upper part of the body (Fig. 1
). Blood testing included: T-tot, 392 ng/dl (normal, 8–60); bioavailable T, 243 ng/dl (normal, 0.8–10); androstenedione, 944 ng/dl (normal, 30–200); and estradiol, 50 pg/ml (normal, 30–400). Ovarian and adrenal venous sampling showed that the T production most likely derived from the right ovary, but was not conclusive. Additional evaluation with (fluorine-18)-2-deoxyglucose positron emission tomography (FDG-PET) showed increased uptake in the right ovary (Fig. 2). A second ovarian US showed an enlarged and partially cystic right ovary. Right oophorectomy was performed, and histological examination confirmed an intermediately differentiated Sertoli Leydig cell tumor. Serum T-tot concentrations obtained 3 d and 4 wk after surgery were 11 and 27 ng/dl, respectively.
Contrary to previous reports (1, 2), this case illustrates that FDG-PET can localize a T-secreting ovarian neoplasm. Although benign luteal cysts also may show FDG-PET uptake (3, 4), our patient was amenorrheic, and a luteal cyst was not found on pathology. The cystic change found with the second ovarian US probably represented differences in the neoplasm over time and operator technique. We suggest that FDG-PET can be used in the localization of T-secreting neoplasms when CT, US, and venous sampling studies are inconclusive.
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Footnotes
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Abbreviations: CT, Computed tomography; FDG-PET, (fluorine-18)-2-deoxyglucose positron emission tomography; T, testosterone; T-tot, total testosterone; US, ultrasound.
Received October 13, 2005.
Accepted December 5, 2005.
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References
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