The diagnostic differential then between tumor the ovary and adrenal gland as the cause excessive testosterone production and virilization.
The most common virilizing ovarian tumor the SertolrLeydig cell essay writers canada tumor, or arrhenoblastoma. Other virilizing ovarian tumors include the hilus-cell or Leydig-cell tumor which have typical crystalloids Reinke lipoid-cell tumor and rarely Brenner tumors, dissertation writing consultant Krukenberg tumors, cystadenocarcinomas, and pseudomucinous cystadenomas.
Adrenal tumors may pure Cortisol secreting, in which case they not demonstrate evidence virilization, but may cause increased hair growth a downy type. They may produce both Cortisol and androgen, with features very similar Gushing disease, or may associated primarily with androgen production.
Adrenal carcinomas may cause Cushing's syndrome and are known frequently cause very Adenomas the adrenal are common about some autopsy series however, they are rarely associated proquest thesis search with any endocrine disorder. If lipofuscin present, the tumor may appear black.
Black adenomas with endocrine function Androgen secreting adrenal tumors present with evidence virilization and menstrual disturbances, with a relatively sudden onset and rapid progression over a period weeks months. The usual clinical features are hirsutism, acne, temporal recession hairline and thinning scalp hair, increased or decreased libido, deepening voice, increased muscle mass, and clitoral enlargement. The disorder may develop at any time from childhood old age. Levels circulating androgens, including testosterone, androstenedione, DHEA, DHEA-sulfate and urinary ketosteroid excretion are increased in affected patients. Usually, as mentioned earlier, disease the adrenal cortex causes virilization through production increased amounts ketosteroids primarily DHEA, DHEA-sulfate and androstenedione which are peripherally converted testosterone.
The ovaries can cause virilization through the direct secretion testosterone.
In the past has been stated that normal urinary ketosteroids dissertation proposal service practically excluded the presence an adrenal lesion as the cause virilization. However, as the present case demonstrates, there are cases virilizing adrenal tumors associated with markedly elevated testosterone levels, but normal levels DHEA.
Various methods have been utilized in attempts identify the source testosterone, including ultrasonography, laperoscopy, abdominal computerized scanning, adrenal radio-isotope scanning radioiodinated cholesterol scanning, and selective sampling from adrenal and ovarian veins for measurement androgens.
Endocrinologic suppression and stimulation tests have been limited value A review the literature reveals reported cases similar the one presented.
All these patients have custom essays usa virilizing adrenal tumors associated with elevated serum testosterone levels but normal urinary excretion ketosteroids. Eleven patients including the one presented were older than. All cases had normal hour urinary ketosteroid levels. The DHEA-sulfate was normal in four cases, DHEA in four, androstenedione in six. Adrenal cortical adenomas were present. Ganglioneuromas were noted in two cases. There was also one case mixed cortical adenoma and ganglioneuroma, and one case had pleomorphic tumor cells with areas suggestive primitive sex cords. Crystalloids Reinke and other histologic features resembling Leydig cells were observed in three cases.