Hyperandrogenism in a postmenopausal woman presenting with a metastatic ileum endocrine tumor.

OBJECTIVE

To elucidate the mechanism of the hyperandrogenism found in a postmenopausal woman presenting an ileum endocrine tumor with ovarian metastases.

DESIGN

Case report.

SETTING

University hospital.

PATIENT(S): A postmenopausal woman was referred for hirsutism. Basal plasma testosterone was high, 6.6 nM/L (normal, <or=0.7 nM/L). Pelvic magnetic resonance imaging revealed a 6-cm left ovarian mass.

INTERVENTION(S): Bilateral salpingo-oophorectomy was performed. Pathological examination found a bilateral metastatic endocrine ovarian tumor, associated with a functional stroma. A primary ileum endocrine tumor was discovered and resected.

MAIN OUTCOME MEASURE(S): Immunohistochemical study of the expression of steroidogenic enzymes and beta and alpha subunits of hCG.

RESULT(S): Immunohistochemical expression of steroidogenic enzymes was found in the ovarian stromal tissue surrounding the tumor but not in the metastatic tumoral cells. A substantial percentage of the metastatic tumoral cells was immunopositive for the beta and alpha subunit of hCG but not the ileal cells.

CONCLUSION(S): These data suggest an hCG paracrine effect of the ovarian metastases tumor on the adjacent interstitial cells, resulting in the virilization of the patient.