Abstract: Objective　To analyze the etiology，clinical manifestations and pathological features of androgen-secreting tumors（AST） in women，offering a reference for the diagnosis，treatment and prognosis improvement of the disease.Methods　Twenty patients with postsurgical pathology confirmed AST 〔AST arising from ovaries in 11 cases（ovary tumor group） and from adrenals in 9 cases（adrenal tumor group）〕 were recruited from Chinese PLA General Hospital between January 2012 and January 2018.A retrospective analysis was conducted on their personal characteristics，clinical manifestations，laboratory findings，imaging features，pathological features and prognosis.Results　The average age for ovary tumor group and adrenal tumor group was（37.4±20.2）（32.2±14.8） years old，respectively.The average duration of AST was（2.8±2.7） years（range：7 months to 10 years） for ovary tumor group，and（0.7±0.6） years（range：7 days to 2 years） for adrenal tumor group.All the cases in ovary tumor group showed virilism，and 10 showed de-feminization.In the adrenal tumor group，5 demonstrated virilism，and 4 demonstrated de-feminization.The serum levels of testosterone（T），17-hydroxyprogesterone（17-OHP），and dehydroepiandrosterone sulfate（DHEAS） were 14.1（9.0，25.4） nmol/L，（2.5±0.8） μg/L，（188±101） μg/dl，respectively for ovary tumor group，and 7.1（4.9，16.1） nmol/L，（6.2±3.3） μg/L，（676±312） μg/dl，respectively for adrenal tumor group.In the ovarian tumor group，10 were found with tumor by transvaginal ultrasonography，and other 1 was found by surgical exploration.The average diameter of the tumor was（5.2±3.2） cm，which had no linear correlation with serum T level（r=-0.50，P>0.05）.In the adrenal tumor group，the tumor was found by enhanced adrenal gland CT in all cases.The average diameter of tumor was（10.7±4.1） cm，which showed no linear correlation with serum T level（r=-0.23，P>0.05）.Postsurgical pathological test found that in the ovarian tumor group，3 were found with Sertoli-Leydig cell tumors，7 with ovarian steroid cell tumors，and 1 with teratoma；in the adrenal tumor group，3 were found with adrenocortical adenoma，and other 6 with adrenocortical adenocarcinoma.During the follow-up period，9 cases of ovarian tumors survived，but other 2 were lost to follow-up；4 cases of adrenal tumors survived，2 died，and other 3 were lost to follow-up.Conclusion　Both androgen-secreting ovarian tumors and androgen-secreting adrenal tumors could cause virilism and defeminization.Moreover，both of them could significantly increase the serum T level，but showed no significant difference in the growth level.Compared with patients with androgen-secreting ovarian tumors，those with androgen-secreting adrenal tumors had higher serum levels of 17-OHP and DHEAS，larger tumor diameter，and poorer prognosis.

Key words: Hyperandrogenism, Ovarian neoplasms, Adrenal gland neoplasms

摘要： 目的　分析和总结女性分泌雄激素肿瘤病因、临床表现及病理特征，探讨此类肿瘤的诊治及预后。方法　选取2012年1月—2018年1月在中国人民解放军总医院经手术病理证实为分泌雄激素肿瘤的20例患者，其中11例来源于卵巢（卵巢肿瘤组），9例来源于肾上腺（肾上腺肿瘤组）。回顾性分析患者的一般资料、临床表现、实验室特点、影像特点、病理特点及预后。结果　卵巢肿瘤组平均发病年龄（37.4±20.2）岁；肾上腺肿瘤组平均发病年龄（32.2±14.8）岁。卵巢肿瘤组病程为7个月~10年，平均病程为（2.8±2.7）年；均表现为男性化；10例（10/11）患者表现为去女性化。肾上腺肿瘤组病程为7 d~2年，平均病程为（0.7±0.6）年；5例（5/9）患者表现为男性化；4例（4/9）患者表现为去女性化。卵巢肿瘤组血清睾酮（T）水平为14.1（9.0，25.4）nmol/L，血清17-羟孕酮（17-OHP）水平为（2.5±0.8）μg/L，血清硫酸去氢表雄酮（DHEAS）水平为（188±101）μg/dl；肾上腺肿瘤组血清T水平为7.1（4.9，16.1）nmol/L，血清17-OHP水平为（6.2±3.3）μg/L，DHEAS水平为（676±312）μg/dl。卵巢肿瘤组中10例（10/11）患者经阴道超声检出阳性，另1例（1/11）经手术探查发现，卵巢肿瘤组患者肿瘤直径为（5.2±3.2）cm，其肿瘤直径与血清T水平无直线相关关系（r=-0.50，P>0.05）。肾上腺肿瘤组均通过肾上腺增强CT检出，肿瘤直径为（10.7
±4.1）cm，其肿瘤直径与血清T水平无直线相关关系（r=-0.23，P>0.05）。11例卵巢肿瘤患者术后病理提示3例（3/11）为支持-间质细胞瘤，7例（7/11）为脂质细胞瘤，1例（1/11）为畸胎瘤。9例肾上腺肿瘤患者3例（3/9）为肾上腺皮质腺瘤，6例为肾上腺皮质腺癌。11例卵巢肿瘤患者随访时9例存活，2例失访。肾上腺肿瘤患者随访时4例存活，3例失访，2例死亡。结论　分泌雄激素卵巢肿瘤及肾上腺肿瘤均可出现男性化、去女性化，二者均可使T水平明显升高，但无明显差异。肾上腺肿瘤组的血清17-OHP及DHEAS水平较卵巢肿瘤组高，肿瘤的平均直径也更大，其预后较卵巢肿瘤组更差。

关键词: 雄激素增多症, 卵巢肿瘤, 肾上腺肿瘤