Diagnostik bei progredientem Hirsutismus. Kathetertechnik und Ergebnisse

Abstract

Catheterization of adrenal and ovarian veins in combination with hormone concentration analyses was performed in seventy hirsute women. There was suspicion of tumor in 30 cases because of excess androgen production (plasma testosterone more than 1,5 ng/ml and/or plasma dehydroepiandrosterone sulfate more than 7000 ng/ml in peripheral blood samplings). Catheterization and blood sampling was done with a femoro-visceral catheter by the transfemoral approach. Contributary blood flows from many different venous systems were found to be more often to the right ovarian and to the left adrenal veins in comparisons to the other side. Catheterization of the wrong vessels occurred without being recognized immediately (circumaortic renal collar, inferior phrenic vein, ascending lumbar vein). These pitfalls might falsify blood samplings. There were no significant complications. Seven ovarian tumors were localized. Their size ranged from 0,5 to 2,5 cm in diameter. They were not recognized during laparoscopy. There were 10 hyperthecoses, four adrenogenital syndromes, one abortive testis, one adrenal adenoma, one Cushing's syndrome and one Cushing's disease due to an adenoma of the pituitary gland. In five patients a diagnosis could not be made. Tumor was excluded in forty patients. Their virilization was of adrenal origin in 32%, of ovarian origin in 29%, and of both adrenal and ovarian origin in 22%. In 17% a source of the excess androgen production was not found. This differential diagnosis is not important for the patient therapy.