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E1988. Practical Approach of Ovarian Venous Sampling and its Role in the Diagnosis and Management of Hyperandrogenism in Women
Authors
  1. Shelly Uppal; Rutgers University-Robert Wood Johnson
  2. Albert Li; Rutgers University-Robert Wood Johnson
Background
Women with clinical features of hyperandrogenism, such as amenorrhea, hirsutism, cystic acne, balding, aggressive behavior, increased libido and virilization are often evaluated by endocrinologists. Most cases of hyperandrogenism are caused by polycystic ovarian syndrome; however, it is essential to rule out less common differentials. Very elevated serum testosterone can be due to adrenal or ovarian tumors. Hyperandrogenism with very elevated serum testosterone can warrant a consultation for venous sampling of the ovaries and/or adrenal glands to localization of suspected tumor. Ovarian and adrenal venous sampling should occur only after verification of clinical findings, laboratory testing, and non-localizing diagnostic imaging exams.

Educational Goals / Teaching Points
Practical approach for interventional radiologists to confidently field hyperandrogenism consultations. Understand causes for falsely elevated testosterone levels. Understand ovarian and adrenal venous anatomy to perform the selective venous sampling procedure. Understand how to interpret the laboratory results of the ovarian/adrenal venous sampling.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Discussion will include comprehensive algorithm for evaluation of hyperandrogenism. An emphasis will be placed on physiological causes and causes of falsely positive elevated testosterone. Adrenal and ovarian imaging will be briefly reviewed. Technique and protocol for ovarian venous and adrenal venous sampling will be reviewed.

Conclusion
In women, with testosterone levels > 150 ng/dL and associated hyperandrogegism symptoms suggests of tumor in the appropriate clinical context.When imaging is non-localizing or non-diagnostic for suspected endocrine tumor, a standardized method for ovarian and adrenal venous blood sampling may help determine the source. Interventional Radiologists need to confidently understand the endocrine laboratory workup, sources of lab error, venous anatomy, protocol for ovarian and adrenal venous sampling, and interpretation of venous sampling results.