Efficacy of selective venous catheterization in localizing a small androgen-producing tumor in ovary.

Background: Androgen-producing tumors, originating mostly in the ovary or adrenal gland, induce hirsutism. It sometimes is difficult to localize the tumor precisely even with modern imaging technology. We used selective venous catheterization and hormonal sampling (SVCHS) to localize an androgen-producing ovarian tumor. Case Report: A 37-year-old woman (gravida 0, para 0) presented with secondary amenorrhea, infertility, and virilization, including hirsutism and progressive balding. Laboratory examination revealed severe hyperandrogenism, with a total testosterone (T) concentration of 13.1 ng/ml and a free T concentration of 28.1 pg/ml. Dehydroepiandrosterone sulfate and androstendione were within normal ranges. Work-up included an abdominal and pelvic ultrasound scan, CT, MRI, and norcholesterol scintigraphy without discovery of the source of the hyperandrogenism. Persistently high plasma T concentrations prompted SVCHS. Eleven blood samples were collected from both the adrenal and the ovarian veins bilaterally. The total T concentration was significantly higher in blood from the right ovarian vein (878 ng/ml). A laparoscopic right oophorectomy was performed. The pathologic diagnosis was a Leydig cell tumor. A rapid decrease in free and total T followed tumor removal, and she became pregnant by in vitro fertilization. Conclusions: SVCHS is highly effective in confirming the presence of a small androgen-producing ovarian tumor.