The utility of adrenal and ovarian venous sampling in a progesterone-producing adrenal tumor and review of the literature

Lian Duan,Yu Gu,Yingying Yang,Hui Pan,Quanzong Mao,Chengyan Deng,Xiaobo Zhang,Boju Pan,Huijuan Zhu

doi:10.1007/s12020-019-02007-7

Abstract

PurposeA clinical case presenting secondary amenorrhea accompanied by an adrenal adenoma and hyperprogesteronemia is described in this study.MethodsSelective catheterization and sampling of adrenal and ovarian veins were performed.ResultsThe source of hyperprogesteronemia was located in the right adrenal gland. A progesterone-producing tumor in the right adrenal gland was diagnosed and removed. Twenty-six days after tumor resection, menstruation occurred.ConclusionsProgesterone-producing tumors should be considered with the presence of an adrenal mass and hyperprogesteronemia. Combined adrenal and ovarian venous sampling may help to identify the source of progesterone secretion.

Highlights

These authors contributed : Lian Duan and Yingying Yang
A 33-year-old woman was admitted to Peking Union Medical College Hospital on November 23, 2017 due to a menstrual disorder that had persisted for 15 years. Her first menarche occurred at 12 years old; the patient had been suffering from oligomenorrhea since 2002, her last menstruation occurred in October, 2014, and she stated that she had a normal sexual life since get married in 2011 and there was no pregnancy despite no contraception
The patient underwent laparoscopic resection of the right adrenal tumor, which was suspected of producing the excess progesterone, 17 α-OHP and cortisol (Table 1)

Summary

Results

The patient underwent laparoscopic resection of the right adrenal tumor, which was suspected of producing the excess progesterone, 17 α-OHP and cortisol (Table 1). A wellencapsulated tumor measuring 2.8 cm × 3.0 cm was removed (Fig. 1E). The cut surface of the tumor was an abnormally deep shade of red unique from other kinds of adrenocortical adenoma. The pathology was reviewed by an experienced endocrine pathologist and suggested adrenocortical adenoma. The tumor cells were arranged in a nesting and trabecular pattern with eosinophilic cytoplasm and obvious nucleoli. The Weiss score was 2, with a nuclear grade between grade II and III; Only 1% of cells expressed Ki-67. With adrenocortical adenoma as a negative control, anti-progesterone antibodies detected progesterone immunoreactivity in the tumor cells (Fig. 2). Progesterone and 17 α-OHP levels normalized immediately after resection of the adrenal tumor (Table 1). The patient’s menstruation reoccurred 26 days after resection, and she was pregnant 3 months post surgery

Introduction

Methods

F P 17 α-OHP E2 T DHEAS PRA ALD

Conclusions

Compliance with ethical standards