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Selective Venous Sampling Prompting Unilateral Oophorectomy in an Adolescent With PCOS and Markedly Elevated Testosterone

  • Kelsee Halpin
    Correspondence
    Address correspondence to: Kelsee Halpin, MD, MPH, Division of Pediatric Endocrinology and Diabetes, Children's Mercy Kansas City, Kansas City, MO 64108.
    Affiliations
    Division of Pediatric Endocrinology and Diabetes, Children's Mercy Kansas City, Kansas City, Missouri

    University of Missouri-Kansas City – School of Medicine, Kansas City, Missouri
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  • Emily Paprocki
    Affiliations
    Division of Pediatric Endocrinology and Diabetes, Children's Mercy Kansas City, Kansas City, Missouri

    University of Missouri-Kansas City – School of Medicine, Kansas City, Missouri
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  • Paige Eickhoff
    Affiliations
    University of Missouri-Kansas City – School of Medicine, Kansas City, Missouri
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  • Douglas C. Rivard
    Affiliations
    University of Missouri-Kansas City – School of Medicine, Kansas City, Missouri

    Department of Radiology, Children's Mercy Kansas City, Kansas City, Missouri
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  • Sahibu Sultan Habeebu
    Affiliations
    University of Missouri-Kansas City – School of Medicine, Kansas City, Missouri

    Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, Missouri
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  • Anne-Marie Priebe
    Affiliations
    University of Missouri-Kansas City – School of Medicine, Kansas City, Missouri

    Division of Pediatric and Adolescent Gynecology, Children's Mercy Kansas City, Kansas City, Missouri
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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) can 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 could nonetheless be therapeutic for severe PCOS.

      Key Words

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