In a patient with hyperandrogenism, which finding most strongly suggests an ovarian or adrenal tumor that should be evaluated with CT abdomen-pelvis?

In a patient with hyperandrogenism, which finding most strongly suggests an ovarian or adrenal tumor that should be evaluated with CT abdomen-pelvis?

• A. Gradual onset with modest testosterone
• B. Rapid onset with high testosterone
• C. Low testosterone with high estrogen
• D. Normal testosterone with suppressed LH

Answer: (B)

Androgen-secreting tumors typically cause rapid onset of virilization with markedly elevated testosterone, which is the strongest signal to image the ovaries and adrenals for a tumor. When symptoms appear quickly and testosterone levels are very high, it raises concern for a neoplasm producing androgens, making CT of the abdomen and pelvis the appropriate next step to localize a tumor. In contrast, gradual onset with only a modest testosterone rise is more consistent with non-tumor causes like PCOS or mild adrenal hyperandrogenism, which do not usually prompt urgent cross-sectional imaging. Normal testosterone with suppressed LH or low testosterone with high estrogen don’t fit the pattern of an androgen-secreting tumor.

Androgen-secreting tumors typically cause rapid onset of virilization with markedly elevated testosterone, which is the strongest signal to image the ovaries and adrenals for a tumor. When symptoms appear quickly and testosterone levels are very high, it raises concern for a neoplasm producing androgens, making CT of the abdomen and pelvis the appropriate next step to localize a tumor. In contrast, gradual onset with only a modest testosterone rise is more consistent with non-tumor causes like PCOS or mild adrenal hyperandrogenism, which do not usually prompt urgent cross-sectional imaging. Normal testosterone with suppressed LH or low testosterone with high estrogen don’t fit the pattern of an androgen-secreting tumor.