A PARADOXICAL INHIBITION OF ANDROGENIC HYPERPRODUCTION BY A SERTOLI-LEYDIG CELL TUMOR OVARY

A 17 year old woman was evaluated for amenorrhoea and severe hirsutism (Ferriman-Gallway index = 31), Pelvic ultrasound demonstrated a right unilateral ovarian mass (6x5 cm), whereas the computed tomography for the adrenal gland was normal, Endocrinological findings revealed norm al concentrations of oestradiol, progesterone, dihydroepiandrosterone sulphate, cortisol, prolactin, follicle-stimulating hormone, luteinizi ng hormone and adrenocorticotrophic hormone (ACTH), Total testosterone , free testosterone, androstenedione and 17-hydroxy-progesterone conce ntrations, already elevated at basal conditions, did not increase afte r an ACTH test, whereas they decreased significantly after dexamethaso ne administration and increased after a human chorionic gonadotrophin test. Of all the tumour markers investigated, tissue polypeptide antig en and alpha(1)-fetoprotein showed an increase in concentration, Selec tive venous ovarian catheterization indicated the presence of an andro gen-producing tumour in the right ovary, The histopathological diagnos is was consistent with a Sertoli-Leydig cell tumour ranking between an intermediate and a poor grade of differentiation, with heterologous e lements characterized by mucinous epithelium of the gastro-intestinal type, An endocrine evaluation performed postoperatively showed a norma lization of all serum pathological hormones and tumour markers studied , Some particular aspects were focused on and discussed.