Interesting problem. I have found a couple of papers in my files on ovarian and adrenal vein studies for androgens which might be useful:
Fertil Steril 1984;42:69 and 42:585
Clin Endocrinol 2003;59:34
Acta Obstet Gynecol Scand 1992;71:245
Gynecol Endocrinol 1988;2:331
We wrote up a series of women with ovarian hyperthecosis which produced similarly raised circulating concentrations of androgens (Clin Endocrinol 1997;46:123) but this was after the menopause, no experience of such hyperthecosis before. Will await the histological diagnosis.
Julian
>>> "TICKNER TREVOR (RM1) Norfolk and Norwich University Hospital" <[log in to unmask]> 12/02/2009 12:03 >>>
I received this from an endocrinologist and any thoughts would be
welcome. The venous sampling results are below.
I have a young lady (dob 2/1/1980) who I am investigating for
hirsutes. Her bloods show that she has high levels of T, androstenedione
and DHEAS. Her adrenal and ovarian imaging is essentially normal.
She has had venous sampling on 2/2/09 which show that she has high
levels of T and andostenedione coming out of both adrenals, but
interestingly normal DHEAS levels. Her 17 OHP with ACTH stimulation does
not suggest CAH. However, I am wondering about other unusual causes of
these findings. With regards to the androstenedione, the results just
say >35 nmol/L. is it possible to get these results more accurately, say
by diluting the sample?
ADRENAL AND OVARIAN VENOUS SAMPLING
Sample location Testosterone
Andreostenedione DHEAS
nmol/L
nmol/L umol/L
Right Hepatic Vein 7.7
8.7 13.7
Right Renal Vein 7.5
20.2 14.6
Left Renal Vein 5.4
20.2 15.2
Left Adrenal 25.0
>35.0 19.7
Infra Hepatic IVC 5.1
17.2 15.1
Left Ovarian 5.0
19.0 14.2
Left Internal Iliac 5.7
19.3 14.6
Left Common Iliac 6.0
17.4 14.6
Right Ovarian 6.3
28.8 15.1
Infra Ranal IVC 5.6
16.7 13.9
Right Adrena 1 26.3
>35.0 17.8
Right adrenal 2 17.2
>35.0 16.9
Right Common Iliac 6.3
17.9 15.2
Right Internal Iliac 7.1
26.3 14.4
Peripheral 6.4
16.1 14.4
Trevor Tickner,
Norwich
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