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

Published:October 26, 2022DOI:



      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Committee on Adolescent Health Care
        Screening and management of the hyperandrogenic adolescent: ACOG committee opinion, Number 789.
        Obstet Gynecol. 2019; 134: :e106-e114
        • Carmina E
        • Rosato F
        • Jannì A
        • Rizzo M
        • Longo RA.
        Relative Prevalence of Different Androgen Excess Disorders in 950 Women Referred because of Clinical Hyperandrogenism.
        J Clin Endocrinol Metab. 2006; 91: 2-6
        • Kaltsas GA
        • Mukherjee JJ
        • Kola B
        • Isidori AM
        • Hanson JA
        • Dacie JE
        • et al.
        Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women?.
        Clin Endocrinol (Oxf). 2003; 59: 34-43
        • Witchel SF
        • Burghard AC
        • Tao RH
        • Oberfield SE.
        The diagnosis and treatment of PCOS in adolescents: an update.
        Curr Opin Pediatr. 2019; 31: 562-569
        • Moltz L
        • Pickartz H
        • Sörensen R
        • Schwartz U
        • Hammerstein J.
        Ovarian and adrenal vein steroids in seven patients with androgen-secreting ovarian neoplasms: selective catheterization findings.
        Fertil Steril. 1984; 42: 585-593
        • Ibáñez L
        • Oberfield SE
        • Witchel S
        • et al.
        An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence.
        Horm Res Paediatr. 2017; 88: 371-395
        • Levens ED
        • Whitcomb BW
        • Csokmay JM
        • Nieman LK.
        Selective venous sampling for androgen-producing ovarian pathology.
        Clin Endocrinol (Oxf). 2009; 70: 606-614
        • Agarwal MD
        • Trerotola SO.
        Combined adrenal and ovarian venous sampling to localize an androgen producing tumor.
        Cardiovasc Intervent Radiol. 2010; 33: 1266-1269
        • Driano BA
        • Creo AL
        • Kumar S
        • Chattha AJ
        • Lteif AN.
        Ovarian steroid cell tumor masquerading as steroid-unresponsive congenital adrenal hyperplasia.
        AACE Clin Case Rep. 2021; 7: 261-263
        • Huang-Doran I
        • Kinzer AB
        • Jimenez-Linan M
        • et al.
        Ovarian Hyperandrogenism and Response to Gonadotropin-releasing Hormone Analogues in Primary Severe Insulin Resistance.
        J Clin Endocrinol Metab. 2021; 106: 2367-2383
        • Goyal A
        • Malhotra R
        • Kulshrestha V
        • Kachhawa G.
        Severe hyperandrogenism due to ovarian hyperthecosis in a young woman.
        BMJ Case Rep. 2019; 12e232783
        • Pascale MM
        • Pugeat M
        • Roberts M
        • et al.
        Androgen suppressive effect of GnRH agonist in ovarian hyperthecosis and virilizing tumours.
        Clin Endocrinol (Oxf). 1994; 41: 571-576
        • Kaaijk EM
        • Hamerlynck JV
        • Beek JF
        • van der Veen F.
        Clinical outcome after unilateral oophorectomy in patients with polycystic ovary syndrome.
        Hum Reprod. 1999; 14: 889-892