{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T06:32:34Z","timestamp":1793082754818,"version":"4.5.0"},"reference-count":0,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,11,7]],"date-time":"2017-11-07T00:00:00Z","timestamp":1510012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:label\/><jats:p>Postmenopausal hyperandrogenism can be tumour\u2010 or non\u2010tumour\u2010related, with pathology residing either in the ovary or adrenal gland(s). The tempo of investigation is determined by the clinical severity of hyperandrogenism (presence\/absence of actual virilisation) and degree of serum testosterone elevation. When clinical or biochemical hyperandrogenism is severe, rapidly developing, or associated with hypercortisolism, screening for adrenocortical or ovarian carcinoma with cross\u2010sectional imaging should be prioritised over detailed biochemical evaluation. Adrenal hyperandrogenism is readily characterised, both biochemically and radiologically. By contrast, even a combination of high\u2010resolution imaging with laboratory evaluation, including dynamic endocrine testing, often cannot distinguish between ovarian hyperthecosis (OH) and virilising ovarian tumour (VOT); a definitive diagnosis usually emerging only after histological examination of excised ovaries. VOTs are typically below the resolution\u2010limit of current imaging modalities and exhibit suppression of gonadotropin\u2010dependent androgen secretion with GnRH\u2010analogue therapy. Thus, for well\u2010characterised ovarian hyperandrogenism, laparoscopic bilateral salpingo\u2010oophorectomy may serve both as a diagnostic and therapeutic procedure. Nevertheless, women unable or unwilling to undergo ovarian surgery can be reassured that malignant VOTs are exceedingly rare and that long\u2010term medical therapy with oral antiandrogens or GnRH\u2010analogues is safe and well\u2010tolerated. OH is strongly associated with insulin\u2010resistance, with hyperinsulinaemia acting synergistically with raised gonadotropin levels to stimulate thecal cell hyperplasia and androgen secretion by the postmenopausal ovary, which lacks granulosa cell aromatase activity and thus cannot convert testosterone to 17 beta estradiol. Thus, features of metabolic syndrome may indicate OH, and significant reductions in androgens can thereby potentially be achieved with lifestyle measures and\/or insulin\u2010sensitising drugs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.13492","type":"journal-article","created":{"date-parts":[[2017,10,5]],"date-time":"2017-10-05T00:52:37Z","timestamp":1507164757000},"page":"13-20","source":"Crossref","is-referenced-by-count":27,"title":["Clinical Case Seminar: Postmenopausal androgen excess\u2013challenges in diagnostic work\u2010up and management of ovarian thecosis"],"prefix":"10.1111","volume":"88","author":[{"given":"Yaasir","family":"Mamoojee","sequence":"first","affiliation":[{"name":"Department of Endocrinology Newcastle\u2010upon\u2010Tyne Hospitals Newcastle Upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murali","family":"Ganguri","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Newcastle\u2010upon\u2010Tyne Hospitals Newcastle Upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norman","family":"Taylor","sequence":"additional","affiliation":[{"name":"Steroid Laboratory Kings College Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Quinton","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Newcastle\u2010upon\u2010Tyne Hospitals Newcastle Upon Tyne UK"},{"name":"Institute of Genetic Medicine University of Newcastle\u2010upon\u2010Tyne Newcastle Upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11,7]]},"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcen.13492","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.13492","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T10:02:37Z","timestamp":1695981757000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cen.13492"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,7]]},"references-count":0,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1]]}},"alternative-id":["10.1111\/cen.13492"],"URL":"https:\/\/doi.org\/10.1111\/cen.13492","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"value":"0300-0664","type":"print"},{"value":"1365-2265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,7]]}}}