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- W1964296413 abstract "Menarche and normal menstruation is the function of a complex interaction of the hypothalamic-pituitary-ovarian axis, and amenorrhea is failure or dysfunction along that axis. Of the ovarian causes of amenorrhea, androgen- secreting ovarian tumors are extremely rare in part because they represent only 5% of all ovarian tumors. Furthermore, only 11% of luteinized thecomas have androgenic manifestations. A previously reported case described a non-malignant luteinized thecoma resulting in secondary amenorrhea. This case is clinically significant for those who evaluate and manage primary amenorrhea. A 15-9/12 year-old Nigerian adolescent complained of primary amenorrhea. Thelarche was between 11 and 12 years of age with subsequent adrenarche. She was a normal weight African female with a normal female body habitus. She had mild acanthosis nigricans, mild hirsutisim, Tanner stage III/IV breast development and Tanner stage V external genitalia with the clitoris at the upper limit of normal in size measuring 2 cm. The hymen and introitus appeared estrogenized and her vagina was pink, moist and rugated. Initial laboratory evaluation revealed normal thyroid stimulating hormone, follicle-stimulating hormone and prolactin. 17-alpha hydroxyprogestrone, other adrenal lab values and testosterone were elevated. See Table 1. Chromosome analysis revealed 46,XX and normal anti-Müllerian hormone. ACTH stimulation testing did not support a diagnosis of congenital adrenal hyperplasia. Renal and pelvic ultrasounds revealed a 5x7cm left adnexal solid mass and an infantile appearing uterus confirmed on MRI. See Figure 1. The patient was taken to the operating room and underwent an exploratory laparoscopy converted to mini-laparotomy and left salpingo-oophorectomy. Final pathology revealed a 6cm benign luteinized ovarian fibrothecoma. The post-operative course was uncomplicated. All labs normalized 3 months post-operatively. See Table 1. She began to have vaginal spotting 3 weeks post-operatively and by 4 months, menses occurred monthly. No further intervention was required. We present this case of primary amenorrhea that has not previously been reported in the modern medical literature. Although a rare cause, virilizing ovarian tumors should be included in the differential diagnosis of an adolescent with primary amenorrhea and hyperandrogenism. Table 1Comparison of pre-operative and 3-month post-operative lab evaluationPre-operative Lab ValuesPost-operative Lab valuesTestosterone ng/dL74 ng/dL15 ng/dL17 OH Progestrone774 ng/dL48 ng/dLDHEA-S170 ng/dL198 ng/dLAndrostenedione452 ng/dL56 ng/dL17 OH Pregnenolone399 ng/dL38 ng/dLDHEA653 ng/dL480 ng/dL11 Deoxycortisol11 ng/dL<10 ng/dLPregnenolone589 ng/dL132 ng/dLProgestrone448 ng/dL162 ng/dL Open table in a new tab" @default.
- W1964296413 created "2016-06-24" @default.
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- W1964296413 date "2012-04-01" @default.
- W1964296413 modified "2023-09-25" @default.
- W1964296413 title "Primary Amenorrhea in an Adolescent Secondary to a Virilizing Luteinized Thecoma of the Ovary" @default.
- W1964296413 doi "https://doi.org/10.1016/j.jpag.2011.12.030" @default.
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