SAT360 Ovarian Vein Sampling in a Pre-menopausal Woman with Hyperandrogenism: Characterization of Hormonal Profiles
Authors: Hu Tina Y , Babey Muriel E , Niu Isabella , Nanavati Sujal M , Murphy Elizabeth J 
Published: October 2023

Abstract
Disclosure: T.Y. Hu: None. M.E. Babey: None. I. Niu: None. S.M. Nanavati: None. E.J. Murphy: None.
Background: Serum estradiol levels have been studied in pre-menopausal and post-menopausal women. There is limited literature on ovarian vein estradiol concentrations. Most data are from sampling done in the setting of hyperandrogenism and primarily in post-menopausal women. This case illustrates hormone concentrations in a pre-menopausal woman who underwent ovarian vein sampling in the workup of hyperandrogenism. Clinical Case: A 33-year G1P1 woman with hypertension and prediabetes presented with three years of menstrual irregularity and infertility after IUD removal. She reported rapid weight gain and hirsutism over one year. Exam was consistent with hyperandrogenism with virilization (modified Ferriman-Gallwey score of 30). Labs showed elevated total testosterone ranging from 144-208 ng/dL (ref 2-45 ng/dL), free testosterone 32.7-35 pg/mL (ref 1.3-9.2 pg/mL), and androstenedione 2.053 ng/ml (ref 0.26-2.14 ng/ml). Cortisol post 1 mg dexamethasone suppression test, 24-hour urine free cortisol, and DHEA-S were normal. Morning unstimulated 17-hydroxyprogesterone was 80.41 ng/dL (ref follicular phase 15-70 ng/dL, luteal phase 35-290 ng/dL). Given normal DHEA-S, an adrenal etiology such as adrenocortical carcinoma was less likely. CT showed no adrenal or ovarian masses. Transvaginal ultrasound revealed numerous bilateral peripheral follicles without adnexal masses or evidence of hyperthecosis and appearance suggestive of PCOS. While the testosterone elevation could be consistent with PCOS, the clinical picture was more concerning for an androgen-secreting tumor. Given the concern for ovarian etiology and patient’s desire for fertility, ovarian vein sampling was performed by a radiologist experienced with adrenal vein sampling to localize a suspected tumor. The right ovarian vein is generally harder to sample than the left. Results were consistent with androgen hypersecretion on the right (right: total testosterone 5,817 ng/dL, androstenedione &gt;40 ng/mL, DHEA-S 20.084 ng/mL; left: total testosterone 189 ng/dL, androstenedione 1.798 ng/mL, DHEA-S 1.893 ng/mL). Estradiol levels were notably elevated on the right at 1945 pg/mL compared to 70 pg/mL on the left. The patient underwent right oophorectomy with pathology showing nodular stromal hyperthecosis and a large corpus luteum cyst. Hyperandrogenism resolved post-operatively with total testosterone 14 ng/dL. Conclusion: We report hormonal profiles from ovarian vein sampling in a pre-menopausal woman with unilateral stromal hyperthecosis. There is limited literature on ovarian vein in this entity and no prior data on estradiol levels. We hypothesize estradiol levels were elevated due to aromatase activity in the right ovary. Testing from the presumably unaffected left ovarian vein helps to characterize ovarian vein estradiol levels in a pre-menopausal woman with suspected hyperandrogenic anovulation.
Presentation Date: Saturday, June 17, 2023