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Berbegal, M.P. Albares, F.J. De-Leon, G. Negueruela" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Berbegal" "email" => array:1 [ 0 => "lauraberbegal@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.P." "apellidos" => "Albares" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "F.J." "apellidos" => "De-Leon" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "G." "apellidos" => "Negueruela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Endocrinología, Hospital General Universitario de Alicante, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alopecia e hirsutismo en una mujer posmenopáusica como forma de presentación de un tumor de células de Leydig hiliar del ovario" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 812 "Ancho" => 2168 "Tamanyo" => 330204 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Triangular-shaped frontoparietal hairline recession. B, Hair thinning on the crown.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Female androgenetic alopecia is one of the main causes of hair loss, and affects 50% of women in their lifetime.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Alopecia and hirsutism as a manifestation of hyperandrogenism in postmenopausal women can have various causes, ranging from normal physiological changes to an ovarian or adrenal tumor. Recommended tests in any woman presenting with alopecia are a detailed clinical history, physical examination, general blood tests (including complete blood count and thyroid stimulating hormone and ferritin levels) and a hormone study with measurement of dehydroepiandrosterone sulfate and total and free testosterone levels.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 65-year-old woman who presented with a 1-year history of hair loss and black facial hair. There was no past history of alopecia, hirsutism, or hyperandrogenism. Her history was remarkable for cardiovascular risk factors (hypertension, dyslipidemia, and diabetes mellitus), and she was also being monitored by the endocrinology department for euthyroid goiter. The physical examination showed frontoparietal hair loss in a triangular-shaped pattern (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> A) and diffuse thinning on the crown (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> B). These findings were consistent with male-pattern female hair loss grade II in the Ebling classification system. The patient also had hirsutism (Ferriman-Gallwey score 9), located predominantly on the face and sides of the neck but also in the chin area (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Examination of the external genitalia revealed an enlarged clitoris. There were no other signs of virilization, such as voice deepening or increased muscle bulk.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Considering the physical findings, we requested blood tests with complete blood count, biochemistry, erythrocyte sedimentation rate, thyroid hormones, and iron profile. The results were all within normal ranges. A hormone study showed hyperandrogenism, with elevated testosterone levels (4.06<span class="elsevierStyleHsp" style=""></span>ng/mL; normal range, 0.20-0.80<span class="elsevierStyleHsp" style=""></span>ng/mL). The tests also showed a level of 28<span class="elsevierStyleHsp" style=""></span>nmol/L for sex hormone binding globulin (normal range, 11-124<span class="elsevierStyleHsp" style=""></span>nmol/L) and a free testosterone index of 45 (normal range, 1.6-6). Free testosterone is the biologically active fraction of testosterone. Androstenedione, dehydroepiandrosterone sulfate, and 17-hydroxyprogesterone levels were all within normal limits. Estradiol levels were high due to peripheral aromatization of testosterone.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The results suggested an ovarian tumor and we ordered a vaginal ultrasound, which revealed no alterations. The patient was referred to the endocrinology department for further testing, including tumor marker and imaging tests. Prolactin and cortisol tests were normal, as were the results for all tumor markers analyzed except carcinoembryonic antigen, with a level of 14.5<span class="elsevierStyleHsp" style=""></span>ng/mL (normal range, 0-5<span class="elsevierStyleHsp" style=""></span>ng/mL). An abdominal computed tomography scan showed images consistent with a left adrenal tumor (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Magnetic resonance imaging of the pelvis showed no signs of an ovarian tumor. With these findings, it was decided to perform a left adrenalectomy, but the patient continued to show high testosterone levels (4.06<span class="elsevierStyleHsp" style=""></span>ng/mL; normal range, 0.20-0.80) and a high free testosterone index (42.6; normal range, 1.6-6) after the operation. Finally, given the strong suspicion of hyperandrogenism of ovarian origin, we performed a bilateral adnexectomy.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The histologic study confirmed a diagnosis of Leydig cell tumor, hilar type, in the right ovary. At the time of writing, 2 months after the adnexectomy, the patient's testosterone levels have returned to normal and there are evident improvements in her hirsutism and alopecia.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Alopecia and hirsutism can be the presenting manifestation of a tumor,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> as shown by the case reported herein. Hilar Leydig cell tumors of the ovary are very rare and account for just 0.5% of all ovarian tumors. Accordingly, very few cases have been described in the literature. Although benign, these tumors frequently cause virilization, with increased androgen production,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3–5</span></a> and they are also associated with an increased risk of thromboembolism.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Leydig tumor cells in the ovary can be very small and may go undetected in imaging studies. This is why adnexectomy is frequently performed as part of a diagnosis of exclusion.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Adnexectomy of just the affected ovary is an option in premenopausal women. The ovary to be removed is identified during surgery by measuring testosterone levels in the ovarian veins.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Hyperandrogenism, particularly with signs of virilization, is very uncommon in postmenopausal women and tends to be due to tumors (mainly of ovarian or adrenal origin).<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Other causes that should be ruled out, however, are drugs, pituitary disorders, and the ectopic production of hormones by tumors. The severity of the hyperandrogenism, the patient's age, and the speed with which signs and symptoms appear are all important diagnostic clues.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Berbegal L, Albares MP, De-Leon FJ, Negueruela G. Alopecia e hirsutismo en una mujer posmenopáusica como forma de presentación de un tumor de células de Leydig hiliar del ovario. Actas Dermosifiliogr. 2015;106:676–678.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 812 "Ancho" => 2168 "Tamanyo" => 330204 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Triangular-shaped frontoparietal hairline recession. B, Hair thinning on the crown.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1171 "Ancho" => 1660 "Tamanyo" => 375421 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hirsutism affecting the chin and sides of the face and neck.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1868 "Ancho" => 1626 "Tamanyo" => 296322 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Left adrenal nodule measuring 2.6<span class="elsevierStyleHsp" style=""></span>cm.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manejo de las mujeres posmenopáusicas en la alopecia androgenética" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 10 | 8 | 18 |
2024 October | 122 | 59 | 181 |
2024 September | 126 | 49 | 175 |
2024 August | 152 | 64 | 216 |
2024 July | 129 | 57 | 186 |
2024 June | 152 | 32 | 184 |
2024 May | 144 | 53 | 197 |
2024 April | 109 | 34 | 143 |
2024 March | 110 | 36 | 146 |
2024 February | 87 | 37 | 124 |
2024 January | 67 | 35 | 102 |
2023 December | 106 | 20 | 126 |
2023 November | 82 | 35 | 117 |
2023 October | 59 | 15 | 74 |
2023 September | 88 | 30 | 118 |
2023 August | 67 | 22 | 89 |
2023 July | 83 | 30 | 113 |
2023 June | 79 | 25 | 104 |
2023 May | 100 | 23 | 123 |
2023 April | 69 | 18 | 87 |
2023 March | 80 | 20 | 100 |
2023 February | 84 | 22 | 106 |
2023 January | 62 | 21 | 83 |
2022 December | 76 | 46 | 122 |
2022 November | 41 | 26 | 67 |
2022 October | 42 | 26 | 68 |
2022 September | 40 | 33 | 73 |
2022 August | 30 | 33 | 63 |
2022 July | 28 | 43 | 71 |
2022 June | 34 | 25 | 59 |
2022 May | 37 | 29 | 66 |
2022 April | 298 | 39 | 337 |
2022 March | 328 | 53 | 381 |
2022 February | 63 | 30 | 93 |
2022 January | 65 | 48 | 113 |
2021 December | 52 | 36 | 88 |
2021 November | 55 | 60 | 115 |
2021 October | 59 | 59 | 118 |
2021 September | 65 | 40 | 105 |
2021 August | 52 | 29 | 81 |
2021 July | 34 | 34 | 68 |
2021 June | 24 | 24 | 48 |
2021 May | 37 | 28 | 65 |
2021 April | 46 | 41 | 87 |
2021 March | 65 | 25 | 90 |
2021 February | 53 | 23 | 76 |
2021 January | 30 | 19 | 49 |
2020 December | 31 | 19 | 50 |
2020 November | 20 | 14 | 34 |
2020 October | 31 | 8 | 39 |
2020 September | 44 | 13 | 57 |
2020 August | 20 | 24 | 44 |
2020 July | 17 | 18 | 35 |
2020 June | 36 | 44 | 80 |
2020 May | 27 | 19 | 46 |
2020 April | 34 | 21 | 55 |
2020 March | 37 | 21 | 58 |
2020 February | 4 | 1 | 5 |
2020 January | 6 | 2 | 8 |
2019 December | 8 | 0 | 8 |
2019 November | 4 | 0 | 4 |
2019 October | 0 | 5 | 5 |
2019 September | 6 | 4 | 10 |
2019 August | 4 | 2 | 6 |
2019 July | 4 | 9 | 13 |
2019 June | 4 | 20 | 24 |
2019 May | 6 | 32 | 38 |
2019 April | 5 | 22 | 27 |
2019 March | 4 | 26 | 30 |
2019 February | 3 | 29 | 32 |
2019 January | 13 | 11 | 24 |
2018 December | 8 | 7 | 15 |
2018 November | 11 | 0 | 11 |
2018 October | 13 | 0 | 13 |
2018 September | 4 | 1 | 5 |
2018 August | 0 | 5 | 5 |
2018 July | 0 | 8 | 8 |
2018 June | 0 | 1 | 1 |
2018 May | 0 | 10 | 10 |
2018 April | 0 | 2 | 2 |
2018 March | 0 | 2 | 2 |
2018 February | 26 | 4 | 30 |
2018 January | 27 | 7 | 34 |
2017 December | 33 | 9 | 42 |
2017 November | 20 | 3 | 23 |
2017 October | 28 | 7 | 35 |
2017 September | 23 | 9 | 32 |
2017 August | 23 | 5 | 28 |
2017 July | 15 | 8 | 23 |
2017 June | 25 | 15 | 40 |
2017 May | 22 | 9 | 31 |
2017 April | 16 | 8 | 24 |
2017 March | 5 | 26 | 31 |
2017 February | 19 | 7 | 26 |
2017 January | 8 | 4 | 12 |
2016 December | 22 | 14 | 36 |
2016 November | 30 | 23 | 53 |
2016 October | 27 | 21 | 48 |
2016 September | 0 | 1 | 1 |
2016 July | 2 | 1 | 3 |
2016 June | 3 | 0 | 3 |
2016 January | 0 | 1 | 1 |
2015 November | 0 | 1 | 1 |