Importance of percutaneous venous catheterization in the identification of the origin of hyperandrogenism

: Selective percutaneous venous catheterization (SPVC) was performed to ascertain the source of androgen excess (AE) in 3 virilized women (12, 50 and 58y) in whom hormonal and radiologic investigation (ultrasonography and computerized tomography) was inconclusive. In all cases, elevated testosterone levels remained unsuppressed with dexamethasone, but were adequately suppressed by normal basal DHEA-S and cortisol. SPVC for T and F determinations (and the T/F ratio) were performed before surgery in all cases and during surgery in case 3. A T/F ratio of 152.4 and 71.8 (with an ovary-peripheral vein gradient [OPG] of 637 and 1173 ng/dl) identified the right and left ovary as the source of androgen excess respectively in cases 1 and 2, whereas the T/F ratio (87.4 and 97.2) and OPG (749 and 1162 ng/dl) were increased in both ovaries in patient 3. Thus, lateralization was evident in cases 1 (R ovary Leydig cell tumor) and 2 (L ovary hemangioma and stromal luteinization) whereas bilateral production in case 3 was confirmed by biopsy (PCO). Pre-operative identification of the origin of AE by SPVC is essential in defining proper treatment for patients suspected of harboring a neoplasia. Because it is not widely available nor devoid of complications, SPVC should only be indicated in hirsute/virilized women whose basal plasma testosterone and DHEA-S levels are in the tumoral range, i.e. higher than 150 ng/dl and 700 micrograms/dl, respectively.