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Ovarian hypersecretion — Clinical Guidelines

Overview

Ovarian hypersecretion refers to conditions characterized by excessive production of ovarian hormones or abnormal ovarian growth, potentially leading to benign or malignant masses. These conditions require careful diagnostic evaluation to differentiate between benign and malignant etiologies to guide appropriate management 1.

Diagnosis

Predictive Models: Utilize models combining patient characteristics, ultrasound markers (e.g., CA-125 levels, ultrasound patterns), and biochemical markers to differentiate between benign and malignant ovarian masses 1.

Imaging: Ultrasound is fundamental, often supplemented by CT or MRI for complex cases 1.

Biochemical Markers: CA-125, HE4, and ROMA index are commonly used, though their specificity and sensitivity vary 1.

Frozen Section Analysis: Whole-slide imaging (WSI) shows excellent correlation with traditional analog interpretation, aiding rapid intraoperative decision-making 5.

Management

Surgical Intervention: Laparoscopic surgery under conscious sedation can be effective for select benign conditions 2.

Conservative Surgery: For low malignant potential tumors, conservative surgical approaches may preserve fertility when appropriate 10.

Hormonal Therapy: Not typically indicated for hypersecretion unless specific hormonal imbalances are targeted 6.

Monitoring: Regular follow-up with imaging and biomarker assessments for benign conditions 1.

Special Populations

Pregnancy: Conservative surgical management can be successful, allowing for subsequent pregnancy in cases of low malignant potential tumors 10.

Pediatrics: Pediatric urologists may encounter ovarian conditions masquerading as urological issues, necessitating multidisciplinary evaluation 4.

Elderly: Management often focuses on minimizing surgical invasiveness and considering comorbidities 2.

Key Recommendations

Utilize predictive models integrating clinical, imaging, and biochemical markers for accurate differentiation between benign and malignant ovarian masses (Evidence: Moderate 1).

Employ whole-slide imaging for frozen section analysis to enhance diagnostic accuracy and efficiency during surgery (Evidence: Moderate 5).

Consider conservative surgical techniques for ovarian serous cystadenocarcinoma of low malignant potential when preserving fertility is a priority (Evidence: Expert opinion 10).

Tailor surgical approaches based on patient age and comorbidities, favoring minimally invasive techniques when feasible (Evidence: Expert opinion 2).

References

1 Mina M, Kosmas I, Tsakiridis I, Mamopoulos A, Kalogiannidis I, Athanasiadis A et al.. Prediction Models of Adnexal Masses: State-of-the-Art Review. Obstetrical & gynecological survey 2021. link 2 Rosati M, Bramante S, Conti F, Frattari A, Rizzi M, Roman RA. Operative Gynecological Laparoscopy Under Conscious Sedation. JSLS : Journal of the Society of Laparoendoscopic Surgeons 2020. link 3 Henderson JT, Harper CC, Gutin S, Saraiya M, Chapman J, Sawaya GF. Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists. American journal of obstetrics and gynecology 2013. link 4 Yiee JH, Betts J, Baskin LS. Ovarian pathology for the pediatric urologist. Urology 2011. link 5 Fallon MA, Wilbur DC, Prasad M. Ovarian frozen section diagnosis: use of whole-slide imaging shows excellent correlation between virtual slide and original interpretations in a large series of cases. Archives of pathology & laboratory medicine 2010. link 6 Nikolaou D. How old are your eggs?. Current opinion in obstetrics & gynecology 2008. link 7 Adám G, Gausz J, Noselli S, Kurucz E, Andó I, Udvardy A. Tissue- and developmental stage-specific changes in the subcellular localization of the 26S proteasome in the ovary of Drosophila melanogaster. Gene expression patterns : GEP 2004. link 8 Lin PS, Gershenson DM, Bevers MW, Lucas KR, Burke TW, Silva EG. The current status of surgical staging of ovarian serous borderline tumors. Cancer 1999. link 9 Siller BS, Gelder MS, Alvarez RD, Partridge EE. Massive edema of the ovary associated with androgenic manifestations. Southern medical journal 1995. link 10 Frederick J, Escoffery C, Mullings A. Successful pregnancy after conservative surgery for ovarian papillary serous cystadenocarcinoma of low malignant potential. The West Indian medical journal 1991. link 11 Wang JC, Chang Chien CC, Chen L. Leiomyoma of the ovary--a case report. Changgeng yi xue za zhi 1989. link 12 Hafiz MA, Toker C. Multicentric ovarian and extraovarian cystadenofibroma. Obstetrics and gynecology 1986. link 13 Persson L, Rosengren E, Sundler F. Immunohistochemical localization of ornithine decarboxylase in the rat ovary. Histochemistry 1982. link

Ovarian hypersecretion