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Selective venous sampling prompting unilateral oophorectomy in an adolescent with PCOS and markedly elevated testosterone

Published:October 26, 2022DOI:https://doi.org/10.1016/j.jpag.2022.10.006

      Abstract

      Background

      For adolescents with suspected polycystic ovary syndrome (PCOS) and severely elevated testosterone concentrations, imaging is recommended to assess for neoplasm. Selective venous sampling (SVS) may be considered when imaging is nondiagnostic.

      Case

      An adolescent female treated for PCOS had a peak testosterone of 344 ng/dL (11.9 nmol/L). Imaging did not localize a mass. SVS implicated the right ovary as the source of hyperandrogenism. Following laparoscopic right oophorectomy, pathology excluded a neoplasm and confirmed PCOS. She subsequently had rapid and persistent improvement in her hyperandrogenism.

      Summary and Conclusion

      Striking testosterone elevation can occur with adolescent PCOS. SVS is a tool for localizing the source of severe hyperandrogenism, yet unilaterality is not always diagnostic of a neoplasm. Unilateral oophorectomy may nonetheless be therapeutic for severe PCOS.

      Keywords

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