ABSTRACT
Descrevemos uma paciente com diabetes tipo 1 com acne e insuficiência renal crônica, em diálise, que apresentou uma dosagem de testosterona total e livre elevada (612 ng/dL, normal < 90 ng/dL e 255 pMol/L, normal: 20-45 pMol/L, respectivamente). Na avaliação clínica, além da acne facial não havia qualquer outro sinal de hiperandrogenismo. Após ter esse resultado confirmado, ela foi submetida à avaliação morfológica de adrenal e ovários (tomografia computadorizada de adrenal e ultrassom pélvico), cujos resultados foram normais. Na ausência de quadro clínico de virilização, foram consideradas outras possibilidades que pudessem explicar a elevação da testosterona, entre as quais a presença de comorbidades (diabetes e insuficiência renal crônica) e falha do método de dosagem. Uma nova determinação da testosterona total, por meio da cromatografia líquida de alta performance como método preparativo e espectrometria de massa em tandem, resultou normal (21 ng/dL), compatível com uma concentração de testosterona total falsamente elevada pela presença de interferentes com o método de dosagem.
The purpose of this report is to present the case of a patient with type 1 diabetes with acne and chronic renal failure on dialysis admitted to the hospital with high total total and free testosterone (612 ng/dL, normal < 90 ng/dL; 255 pMol/L, normal: 20-45 pMol/L). On clinical evaluation, she presented facial acne, and no other signs of hyperandrogenism. As this result was confirmed, she underwent adrenal and ovary morphological assessment (adrenal CT and pelvic ultrasound), which yielded normal results. Due to divergence between clinical and laboratory findings, we considered other possibilities that could explain the elevation of testosterone, including the presence of comorbidities (diabetes and chronic renal failure) and failure of the testosterone assay. Testosterone levels were determined again by high performance liquid chromatography, as a preparative method, and tandem mass spectrometry, yielding normal results (21 ng/dL), which were compatible with a falsely elevated total testosterone level caused by the presence of factors that intereferred with the assay.
Subject(s)
Female , Humans , Acne Vulgaris/blood , Diabetes Mellitus, Type 1/physiopathology , Kidney Failure, Chronic/physiopathology , Testosterone/blood , Virilism/diagnosis , Acne Vulgaris/etiology , Diabetes Mellitus, Type 1/blood , False Positive Reactions , Syndrome , Virilism/bloodABSTRACT
Sertoli-Leydig cell tumor is a group of tumors composed of variable proportions of Sertoli cells, Leydig cells and sometimes heterologous elements. Most tumors are unilateral, confined to the ovaries, and are seen during the second and third decades of life. These tumors are characterized by the presence of testicular structures that produce androgens. Hence, many patients have symptoms of virilization depending on the quantity of and rogen production. We are presenting a case of 16 yrs old girl who presented with symptoms of virilization. She was operated for the ovarian mass. A diagnosis of sertoli-leydig cell tumor was rendered
Subject(s)
Humans , Female , Adolescent , Sertoli-Leydig Cell Tumor/pathology , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/pathology , Virilism/etiology , Virilism/diagnosisABSTRACT
Arrhenoblastoma or Sertoli-Leydig cell tumor is a rare androgen secreting ovarian tumor of unknown pathogenesis, has been reported to co-exist with other neoplasms of the female genital tract. Mostly benign, the tumor originates from the ovarian stromal sex cords, its tissue structure being similar to the Sertoli and Leydig testicular cells. Followed in detail, around one-fifth of these ovarian tumors are found to be malignant. We describe a case of slow growing Sertoli-Leydig cell tumor presenting with androgenic alopecia and virilization, associated with cervical carcinoma in-situ
Subject(s)
Humans , Female , Adult , Ovarian Neoplasms/diagnosis , Carcinoma in Situ , 31574 , Sertoli-Leydig Cell Tumor/diagnosis , Virilism/diagnosis , Virilism/etiologyABSTRACT
El oportuno y adecuado manejo médico de la HSRV por deficiencia de la 21-OH, permite que estos pacientes sobrevivan el período de recién nacido y el primer año de vida. En la peri o pospubertad es frecuente observar signos de hiperandrogenismo que no responden al tratamiento clásico de cortisol a dosis fisiológica y qye es posible controlar con dexametasona (Dex) 0,25 a 0,50 mg nocturna sin efectos colaterales importantes. En este artículo se revisan los criterios actuales de control del tratamiento y se plantea el tratamiento prenatla, cuando existen los recursos adecuados para hacer el diagnóstico prenatal de HSRV, informándose a la madre que ya ha tenido un hijo afectado, que la terapia con Dex 20 ug/kg iniciado en la 5ta. semana de gestación permite evitar o disminuir la malformación intrauterina de los genitales externos de un feto femenino con def de 21-OH
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adrenal Hyperplasia, Congenital/drug therapy , Steroid 21-Hydroxylase/deficiency , Virilism/drug therapy , Dexamethasone/therapeutic use , Glucocorticoids/therapeutic use , Adrenal Hyperplasia, Congenital/diagnosis , Adrenal Hyperplasia, Congenital/embryology , Adrenal Hyperplasia, Congenital/etiology , Pregnancy Complications , Prenatal Diagnosis , Virilism/diagnosis , Virilism/embryology , Virilism/etiologyABSTRACT
Se estudió un grupo de 84 mujeres (promedio de edad 24 años, rango 16 a 37) que consultaron por alguna manifestación del síndrome androgénico cutáneo (75 por ciento acné, 15 por ciento alopecia y 10 por ciento hirsutismo). De este grupo de enfermas, el 54 por ciento presentaba asociado algún tipo de dismenorrea (principalmente oligomenorrea 45 por ciento). Se pudo comprobar que un 52 por ciento de ellas presentaba valores elevados de la 17 alfa-hidroxiprogesterona (x= 1,48 ng/ml), lo cual abrió la sospecha de una hiperplasia adrenal congénica de presentación tardía y leve como causa de androgenismo cutáneo. Este diagnóstico se pudo comprobar en un 7 por ciento por pruebas funcionales, además de haber observado un 8,3 por ciento de poliquistosis ovárica y un 9,5 por ciento de hipotiroidismo