Managing a patient with presumed testosterone-secreting ovarian tumor

We report the case of a 70-year-old woman who was presumed to have right ov arian testosterone-secreting tumor and was treated with long-acting gonadot ropin-releasing hormone agonist therapy plus add-back hormone replacement t herapy. The patient presented with various medical problems including hyper tension, intracranial hemorrhage, myocardial infarction, unstable angina pe ctoris, and poor control of diabetic mellitus and had exhibited rapid sympt oms of androgen excess such as progressive hirsutism and bilateral temporal balding for half a year. Tumor survey was negative except for an elevated testosterone level. Renal vein catheterization successfully detected a righ t ovarian androgen-secreting tumor. Because the patient was deemed medicall y unable to tolerate surgery, she received an alternative treatment consist ing of 6 months of gonadotropin-releasing hormone-agonist (GnRH-a) and add- back hormone replacement therapy (HRT). Serum testosterone levels returned to normal limits after administration of the first dose of GnRH-a. A follow -up tumor survey was negative. The patient has been alive and free of disea se for 8 months after six doses of GnRH-a. We conclude that this strategy m ight be used as urgent therapy in a medically compromised patient with pres umed ovarian androgen-secreting tumor. (C) 1999 Academic Press.