Hyperandrogenism in a postmenopausal woman presenting with a metastatic ileum endocrine tumor

Objective: To elucidate the mechanism of the hyperandrogenism, found in a postmenopausal woman presenting an ileum endocrine tumor with ovarian metastases. Design: Case report. Setting: University hospital. Patient(s): A postmenopausal woman was referred for hirsutism. Basal plasma testosterone was high, 6.6 nM/L (normal, less than or equal to 0.7 nM/L). Pelvic magnetic resonance imaging revealed a 6-cm left ovarian mass. Intervention(s): Bilateral salpingo-oophorectomy was performed. Pathological examination found a bilateral metastatic endocrine ovarian tumor, associated with a functional stroma. A primary ileum endocrine tumor was discovered and resected. Main Outcome Measure(s): Immunohistochemical study of the expression of steroidogenic enzymes and and alpha subunits of hCG. Result(s): Immunohistochemical expression of steroidogenic enzymes was found in the ovarian stromal tissue surrounding the tumor but not in the metastatic tumoral cells. A substantial percentage of the metastatic tumoral cells was immunopositive for the beta and alpha subunit of hCG but not the ileal cells. Conclusion(s): These data suggest an hCG paracrine effect of the ovarian metastases tumor on the adjacent interstitial cells, resulting in the virilization of the patient.