Hyperthecosis

Last updated
Hyperthecosis
Other namesOvarian hyperthecosis
Specialty Gynecology

Hyperthecosis, or ovarian hyperthecosis, is hyperplasia of the theca interna of the ovary. [1] Hyperthecosis occurs when an area of luteinization occurs along with stromal hyperplasia. The luteinized cells produce androgens, which may lead to hirsutism and virilization (or masculinization) in affected women. [2]

Contents

The term hyperthecosis refers to the presence of nests of luteinized theca cells in the ovarian stroma due to differentiation of the ovarian interstitial cells into steroidogenically active luteinized stromal cells. These nests or islands of luteinized theca cells are scattered throughout the stroma of the ovary, rather than being confined to areas around cystic follicles as in polycystic ovary syndrome (PCOS). These luteinized theca cells result in greater production of androgens.

Seen as a severe form of PCOS, the clinical features of hyperthecosis are similar to those of PCOS. [3] Women with hyperthecosis often have more markedly elevated testosterone, more hirsutism, and are much more likely to be virilized. [4] While elevated androgens in postmenopausal women is rare, [5] hyperthecosis can present in both premenopausal or postmenopausal women. Women with hyperthecosis may or may not have always had underlying PCOS. [6]

Cause

The etiology of hyperthecosis is unknown, however evidence suggests a possibility of genetic transmission. Hyperthecosis has been documented in familiar patterns. [7] Insulin resistance may also play a role in the pathogenesis of hyperthecosis. Women with hyperthecosis have a significant degree of insulin resistance and insulin may stimulate the ovarian stromal androgen synthesis. [8]

Prognosis

Although no large studies showing the long term outcomes for women with hyperthecosis exist, a diagnosis of hyperthecosis may suggest an increased risk for metabolic complications of hyperlipidemia and type 2 diabetes . [9] In postmenopausal women, hyperthecosis may also contribute to the pathogenesis of endometrial polyp, endometrial hyperplasia, and endometrioid adenocarcinoma due to the association of hyperestrinism (excess estrins in the body) and hyperthecosis. [10] Treatment for hyperthecosis is based upon each case, but may range from pharmacological interventions to surgical. [11]

See also

Related Research Articles

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Polycystic ovary syndrome, or polycystic ovarian syndrome (PCOS), is the most common endocrine disorder in women of reproductive age. The syndrome is named after cysts which form on the ovaries of some women with this condition, though this is not a universal symptom, and not the underlying cause of the disorder.

<span class="mw-page-title-main">Hirsutism</span> Excessive hair growth on parts of the body where hair is usually minimal

Hirsutism is excessive body hair on parts of the body where hair is normally absent or minimal. The word is from early 17th century: from Latin hirsutus meaning "hairy". It usually refers to a male pattern of hair growth in a female that may be a sign of a more serious medical condition, especially if it develops well after puberty. Cultural stigma against hirsutism can cause much psychological distress and social difficulty. Discrimination based on facial hirsutism often leads to the avoidance of social situations and to symptoms of anxiety and depression.

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<span class="mw-page-title-main">Serous tumour</span> Medical condition

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<span class="mw-page-title-main">Hyperandrogenism</span> Excess androgens (male-related hormones) in the body

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The HAIR-AN syndrome is a rare subtype of polycystic ovary syndrome (PCOS) characterized by hyperandrogenism (HA), insulin resistance (IR) and acanthosis nigricans (AN). The symptoms of the HAIR-AN syndrome are largely due to severe insulin resistance, which can be secondary to blocking antibodies against the insulin receptor or genetically absent/reduced insulin receptor number/function. Insulin resistance leads to hyperinsulinemia which, in turn, leads to an excess production of androgen hormones by the ovaries. High levels of androgen hormones (hyperandrogenism) in females causes excessive hair growth, acne and irregular menstruation. Patients with both underlying mechanisms of insulin resistance may have more severe hyperandrogenism. Insulin resistance is also associated with diabetes, heart disease and excessive darkening of the skin

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Angelica Lindén Hirschberg is a Swedish obstetrician, gynecologist and academic. She is a professor in Obstetrics and Gynecology at Karolinska Institutet, Senior Consultant in the Department of Gynecology and Reproductive Medicine and the Head of Women's Health Research Unit at the Karolinska University Hospital.

References

  1. ↑ Taber's Cyclopedic Medical Dictionary 21st Edition
  2. ↑ Stead, Stead, Kaufman, Suarez (2009). First Aid for the Obstretrics & Gynecology Clerkship - Second Edition. McGraw-Hill
  3. ↑ Zhang, Cunxian; Sung, C. James; Quddus, M. Ruhul; Simon, Rochelle A.; Jazaerly, Tarek; Lawrence, W. Dwayne (2017-01-01). "Association of ovarian hyperthecosis with endometrial polyp, endometrial hyperplasia, and endometrioid adenocarcinoma in postmenopausal women: a clinicopathological study of 238 cases". Human Pathology. 59: 120–124. doi:10.1016/j.humpath.2016.09.021. PMID   27746268.
  4. ↑ "UpToDate".
  5. ↑ Krug, Esther; Berga, Sarah L. (2002-01-01). "Postmenopausal hyperthecosis: Functional dysregulation of androgenesis in climacteric ovary". Obstetrics and Gynecology. 99 (5 SUPPL. 1): 893–897. doi:10.1016/S0029-7844(01)01588-5. ISSN   0029-7844. PMID   11975949. S2CID   31107352.
  6. ↑ Wierman, MD, Margaret (2016). "Polycystic Ovarian Syndrome". Polycystic Ovarian Syndrome : 2016 Meet-The-Professor: Endocrine Case Management. pp. 306–309. doi:10.1210/mtp5.9781943550043.ch57 (inactive 2024-10-06). ISBN   978-1-943550-02-9.{{cite book}}: CS1 maint: DOI inactive as of October 2024 (link)
  7. ↑ Wilroy, R.S. (February 1975). "Hyperthecosis: an inheritable form of polycystic ovarian disease". Birth Defects Original Article Series. 11 (4): 81–5. PMID   1156689 . Retrieved 2017-05-03.
  8. ↑ Nagamani M.D., Manubai (February 1986). "Hyperinsulinemia in hyperthecosis of the ovaries". American Journal of Obstetrics and Gynecology. 154 (2): 384–389. doi:10.1016/0002-9378(86)90676-9. PMID   3511712.
  9. ↑ Rothman, Micol S.; Wierman, Margaret E. (2011-08-01). "How should postmenopausal androgen excess be evaluated?". Clinical Endocrinology. 75 (2): 160–164. doi:10.1111/j.1365-2265.2011.04040.x. ISSN   1365-2265. PMID   21521309. S2CID   205286448.
  10. ↑ Zhang, Cunxian; Sung, C. James; Quddus, M. Ruhul; Simon, Rochelle A.; Jazaerly, Tarek; Lawrence, W. Dwayne (2017-01-01). "Association of ovarian hyperthecosis with endometrial polyp, endometrial hyperplasia, and endometrioid adenocarcinoma in postmenopausal women: a clinicopathological study of 238 cases". Human Pathology. 59: 120–124. doi:10.1016/j.humpath.2016.09.021. ISSN   0046-8177. PMID   27746268.
  11. ↑ Krug, Esther; Berga, Sarah L. (2002-01-01). "Postmenopausal hyperthecosis: Functional dysregulation of androgenesis in climacteric ovary". Obstetrics and Gynecology. 99 (5 SUPPL. 1): 893–897. doi:10.1016/S0029-7844(01)01588-5. ISSN   0029-7844. PMID   11975949. S2CID   31107352.
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