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CASE REPORT
Changing pattern of gonadotropins in a patient with an adrenal-androgen secreting tumor
José Antonio Miguel MarcondesI,
Corresponding author
marcondesmd@uol.com.br

Tel.: 55 11 3159-0582
, Cristiano RG BarcellosI, Michelle P RochaI, Hélio BisiII
I Endocrinology - Hospital das Clínicas de São Paulo, São Paulo, São Paulo, Brazil.
II Patologia - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">There are a few studies about the secretion of gonadotropins in women&#46; Acute testosterone infusion to normal women with and without testolactone inhibits LH sssecretion in a dose-dependent manner&#44; without no effect on FSH secretion&#44;<a class="elsevierStyleCrossRef" href="#bib1">1</a> while short-term administration of testosterone to normal women and eugonadal female-to-male transsexuals did not alter either gonadotropin levels&#44; or affect the pulsatile secretion of LH&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a></p><p id="para20" class="elsevierStylePara elsevierViewall">Regarding the effect of chronic hyperandrogenemia&#44; in polycystic ovary syndrome a specific pattern of gonadotropins secretion has been described&#44; with an increased concentration of basal LH and diminished FSH and with an increase in the frequency of LH pulses&#44;<a class="elsevierStyleCrossRef" href="#bib3">3</a> while in adrenal or ovarian androgen-secreting tumors&#44; gonadotropin levels vary from high&#44;<a class="elsevierStyleCrossRefs" href="#bib4">4-6</a> normal for age<a class="elsevierStyleCrossRefs" href="#bib7">7-9</a> or suppressed&#46;<a class="elsevierStyleCrossRefs" href="#bib7">7&#44;10-11</a> The reason for the different gonadotropins pattern in androgen-secreting tumors is not clear&#46; It is possible that the level of testosterone and the time exposure could influence the secretion of gonadotropins&#44; as postulated by Spinder et al in transsexual<a class="elsevierStyleCrossRef" href="#bib2">2</a> and Bachelot <span class="elsevierStyleItalic">et al</span> in virilizing ovarian tumors&#46;<a class="elsevierStyleCrossRef" href="#bib10">10</a></p><p id="para30" class="elsevierStylePara elsevierViewall">We report one patient with an adrenal androgen-secreting tumor &#40;adrenal adenoma&#41;&#44; where we document for the first time the transition of gonadotropin levels from normal to a suppressed state&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">CASE REPORT</span><p id="para40" class="elsevierStylePara elsevierViewall">A 49-year-old female with a 4-year history of amenorrhea&#44; excessive hair growth&#44; hair loss&#44; and deepening of the voice was admitted to the hospital&#46; She had had normal menstrual cycling since menarche and denied hot flushes&#46; At presentation she denied using any medication in the previous 6 months&#46;</p><p id="para50" class="elsevierStylePara elsevierViewall">Physical examination revealed a normal weight &#40;body mass index of 22&#46;6 kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; parietal temporal baldness&#44; and marked hirsutism&#46; Her muscle mass was slightly enlarged&#46; Blood pressure was 120 &#215; 70 mmHg and heart rate was 76 beats&#47;min&#46; Breasts were hypoatrophic&#44; without masses or galactorrhea&#46; The abdomen was normal&#44; and a pelvic examination revealed clitoromegaly&#46; No anexial mass was palpable&#46;</p><p id="para60" class="elsevierStylePara elsevierViewall">The initial laboratory investigation revealed a normal blood count&#46; Liver and renal functions were within normal range&#46; Basal hormone evaluation revealed an increased level of total testosterone with a level of DHEAS&#44; estradiol and gonadotropins concentration normal for age &#40;<a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#41;&#46; Dexamethasone suppression test &#40;0&#46;5 mg&#44; q&#46;i&#46;d&#46; for 5 days&#41; failed to suppress testosterone levels&#44; whereas cortisol and DHEAS were suppressed normally&#46; Cushing syndrome was ruled out by an overnight dexamethasone suppression test &#40;1&#46;0 mg - cortisol &#60; 1&#46;0 &#956;g&#47;dL&#41;&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p id="para70" class="elsevierStylePara elsevierViewall">Pelvic ultrasonography showed a right ovary of 6&#46;8 cc and a left ovary of 5&#46;8 cc&#44; without nodules or cysts&#46; Computed tomography of the abdomen disclosed a normal right adrenal gland&#46; A solid nodule of 1&#46;58 cm was seen on the left adrenal gland&#46;</p><p id="para80" class="elsevierStylePara elsevierViewall">The patient refused further evaluation at that time&#44; but appeared for a new evaluation 2 years later&#46; Her physical examination was largely unchanged&#44; except for progression of temporal balding&#46; Basal hormone levels of total testosterone and estradiol did not change significantly &#40;<a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#41;&#44; while basal gonadotropin levels were suppressed in two separated samples&#46; After acute GnRH administration&#44; gonadotropin levels remained suppressed&#46;</p><p id="para90" class="elsevierStylePara elsevierViewall">Pelvic ultrasonography showed a right ovary of 2&#46;7 cc and a left ovary of 1&#46;8 cc&#44; without nodules or cysts&#46; On Computed Tomography of the abdomen&#44; the solid nodule on the left adrenal gland was unchanged&#46;</p><p id="para100" class="elsevierStylePara elsevierViewall">The patient underwent a left adrenalectomy by laparoscopy&#46; The tumor measured 4&#46;5 &#215; 4&#46;0 &#215; 2&#46;5 cm and weighed 45 g&#46; Macroscopically&#44; the tumor was encapsulated with a thin&#44; smooth&#44; fibrous capsule&#46; The tumor had a firm consistency with a variable brown to yellow colour on cross-section&#46; There were no haemorrhages&#44; necrosis or cystic degenerations&#46; On microscopical examination&#44; the tumor consisted of large polygonal cell with abundant eosinophilic cytoplasm&#44; which showed focal peripherical basophilic granules and sometimes fine clear&#44; vacuolation&#46; Occasionally&#44; there was some lipofuchsin pigment&#46;</p><p id="para110" class="elsevierStylePara elsevierViewall">The patient was submitted to blood co<span class="elsevierStyleBold">l</span>lection 6 and 45 days and re-examined 60 days after the surgical procedure&#46; Total testosterone and estradiol decreased while gonadotropins increase to postmenopausal range&#46; She reported hot flushes and reduced libido&#44; however male pattern baldness and hirsutism were unchanged&#46;</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">DISCUSSION</span><p id="para120" class="elsevierStylePara elsevierViewall">The patient in this case study is a 49-year-old woman with a history of virilization for four years and an adrenal adenoma&#46; Upon first examination&#44; her basal gonadotropin levels were normal&#46; The patient refused further examination or treatment&#44; and was not seen in our out-patient clinic for two years&#46; Upon her return&#44; basal and GnRH-stimulated gonadotropin levels were suppressed&#44; without significant change in total testosterone and estradiol levels&#46; After surgery&#44; gonadotropins increased to postmenopausal range&#46; As gonadotropin levels in adrenal and ovarian androgen-secreting tumors have been described as variable&#44;<a class="elsevierStyleCrossRefs" href="#bib4">4-11</a> this case led us to question whether the time of exposure of the gonadotrophic axis could be one factor that regulates gonadotropin levels in virilizing syndrome&#46;</p><p id="para130" class="elsevierStylePara elsevierViewall">In patients with polycystic ovary syndrome&#44; a state of chronic mild hyperandrogenemia&#44; dynamic abnormalities of gonadotropins secretion are some of the most prominent findings&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a> High basal LH levels and increased LH pulse amplitude have been described and may be related to elevated oestrogen levels<a class="elsevierStyleCrossRef" href="#bib3">3</a>&#46; This same pattern of abnormality was also described in a patient with a luteinized thecoma of the ovary&#46;<a class="elsevierStyleCrossRef" href="#bib12">12</a></p><p id="para140" class="elsevierStylePara elsevierViewall">In the other hand&#44; there is not a specific pattern of gonadotropin levels in patients with virilizing tumors&#44; except for inhibin-secreting ovarian tumors&#44; where FSH is suppressed and LH can be normal or low&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a> As a rule&#44; gonadotropin levels in androgen-secreting ovarian tumors have been described as normal or suppressed&#46;<a class="elsevierStyleCrossRefs" href="#bib7">7-11</a> Additionally&#44; mean basal LH levels and LH pulse number and amplitude were lower in patients with ovarian tumors than compared to those with PCOS or normal women&#44;<a class="elsevierStyleCrossRef" href="#bib10">10</a> suggesting different mechanisms of hypothalamic or pituitary feedback&#46; In the same way&#44; gonadotropin levels in patients with adrenal androgen-secreting tumors have also been reported as normal or suppressed&#44; and significantly lower than in patients with non-tumors forms of hyperandrogenism&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a></p><p id="para150" class="elsevierStylePara elsevierViewall">As long-term administration of androgens to women leads to virilizing effects&#44; some of them irreversible&#44; the effects of testosterone on gonadotropins secretion in normal women have been studied in female-to-male transsexual subjects&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> Administration of testosterone undecanoate for six-weeks to eugonadal transsexuals&#44; or for three-months to agonadal transsexuals&#44; did not affect the pulsatile secretion of LH or the basal levels of LH and FSH&#44; despite the fact that this regimen resulted in a biologically effective androgen milieu&#46; On the other hand&#44; testosterone-esters administered to agonadal female-to-male transsexuals for at least six months&#44; resulting in higher testosterone levels&#44; were associated with a significant decrease in mean basal LH and FSH levels&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> It is interesting to note that while acute testosterone infusion inhibited LH secretion in a dose-dependent manner&#44; without any effect on FSH secretion<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#44; long term administration was associated with a decrease in both LH and FSH levels<a class="elsevierStyleCrossRef" href="#bib2">2</a>&#46; According to the authors&#44; this could be a consequence of the duration of testosterone exposure&#46;</p><p id="para160" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this is the first documented case of changing patterns of gonadotropins secretion observed in a patient with Virilizing Syndrome&#46; This cannot be attributed to spontaneous fluctuation of gonadotropins secretion because responses to acute GnRH stimuli were blunted&#46; In the same way&#44; there was no change in the androgen milieu&#44; as total testosterone and estradiol levels were unchanged&#46; It could be that the gonadotropins pattern in virilizing states changes with time&#44; as in female-to-male transsexuals&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> In fact&#44; an inhibitory effect of testosterone and dihydrotestosterone on the LH response of GnRH in rat pituitary cells has been reported<a class="elsevierStyleCrossRef" href="#bib14">14</a>&#46; According to this&#44; when the tumor was removed and the testosterone level felt&#44; there was a gradual release of the gonadotrophic axis&#44; with increase of the gonadotropins levels to the status of menopause&#46;</p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSION</span><p id="para170" class="elsevierStylePara elsevierViewall">We report a patient who showed a changing pattern of gonadotropin levels that appeared to be time-dependent&#46; As there were no changes in testosterone and estradiol levels&#44; we postulate that exposure of the hypothalamus-pituitary to an androgen milieu over time can regulate gonadotropin levels in patients with androgen-secreting tumors&#46;</p></span></span>"
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                  \t\t\t\t" scope="col">2<span class="elsevierStyleSup">nd</span> interview<a class="elsevierStyleCrossRef" href="#tfn3-cln_66p355">2</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LH &#40;IU&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;6 - &#60;0&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">FSH &#40;IU&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;1&#46;0 - &#60;1&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;1&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estradiol &#40;pg&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 - 51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Testosterone &#40;ng&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">945&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">637 - 732&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">782&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Progesterone &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#60;0&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#60;0&#46;3 - &#60;0&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#60;0&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#60;0&#46;3&nbsp;\t\t\t\t\t\t\n
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute modulation of the hypothalamic-pituitary axis by intravenous testosterone in normal women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              P Serafini \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              PD Silva \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RJ Paulson \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              K Elkind-Hirsch \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              M Hernandez \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              RA Lobo \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Am J Obst Gynecol"
                        "fecha" => "1986"
                        "volumen" => "155"
                        "paginaInicial" => "92"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of long&#8211;term testosterone administration on gonadotropin secretion in agonadal female to male transsexual compared with hypogonadal and normal women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:5 [
                            0 => """
                              T Spinder \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JJ Spijkstra \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              LJ Gooren \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              PG Hompes \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              JJ van Kessel H&#46;Spijkstra \n
                              \t\t\t\t\t\t\t\t
                              """
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "1989"
                        "volumen" => "68"
                        "paginaInicial" => "7"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1210&#47;jcem-68-1-200"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of gonadotropin pulsatility in hirsute women with normal menstrual cycles and in women with polycystic ovary syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              SL Minanni \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JA Marcondes \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              BL Wajchenberg \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              AM Cavaleiro \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              MA Fortes \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              MA Rego \n
                              \t\t\t\t\t\t\t\t
                              """
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                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Fertil Steril"
                        "fecha" => "1999"
                        "volumen" => "71"
                        "paginaInicial" => "83"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;S0015-0282&#40;98&#41;00514-7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The value of the low-dose dexamethasone suppression test in the differential diagnosis of hyperandrogenism in women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              GA Kaltsas \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AM Isidori \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              BP Kola \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              RH Skelly \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              SL Chew \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              PJ Jenkins \n
                              \t\t\t\t\t\t\t\t
                              """
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2003"
                        "volumen" => "88"
                        "paginaInicial" => "43"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1210&#47;jc&#46;2002-020922"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Amenorrhea and failure to virilize ina patient with a testosterone secreting granulosa cell tumor"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              HC Taylor \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              ME Velasco \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              SG Flores \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              G Berg \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              TR Brown \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Clin Endocrinol"
                        "fecha" => "1982"
                        "volumen" => "17"
                        "paginaInicial" => "67"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1111&#47;j&#46;1365-2265&#46;1982&#46;tb01628&#46;x"
                      ]
                    ]
                  ]
                ]
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            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endocrine studies on ovarian androblastomas &#40;Sertoli-Leydig tumors&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              M Munemura \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              S Inoue \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              R Himeno \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              N Koyama \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              J Mizumoto \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              M Maeyama \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Endocrinol Investigation"
                        "fecha" => "1984"
                        "volumen" => "7"
                        "paginaInicial" => "22"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sex steroids in androgen-secreting adrenocortical tumors&#58; clinical and hormonal features in comparison with non-tumoral causes of androgen excess"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              CB d&#39;Alva \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              G Abiven-Lepage \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              V Viallon \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              L Groussin \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              MA Dugue \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              X Bertagna \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "European J Endocrinol"
                        "fecha" => "2008"
                        "volumen" => "159"
                        "paginaInicial" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
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              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Activating mutation of the stimulatory G protein &#40;gsp&#41; as a putative cause of ovarian and testicular human stromal Leydig cell tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              MC Fragoso \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AC Latronico \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              FM Carvalho \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              MC Zerbini \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              JA Marcondes \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              LM Araujo \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "1998"
                        "volumen" => "83"
                        "paginaInicial" => "8"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1210&#47;jc&#46;83&#46;6&#46;2074"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A virilizing Leydig cell tumor of the ovary associated with stromal hyperplasia under gonadotropin control"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              JA Marcondes \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              M Nery \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              BB Mendon&#231;a \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              SA Hayashida \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              HW Halbe \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              FM Carvalho \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Endocrinol Investigation"
                        "fecha" => "1997"
                        "volumen" => "20"
                        "paginaInicial" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Luteinizing hormone pulsatility in patients with major ovarian hyperandrogenism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              A Bachelot \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              K Laborde \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JL Bresson \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              G Plu-Bureau \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              A Raynaud \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              X Bertagna \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Endocrinol Investigation"
                        "fecha" => "2007"
                        "volumen" => "30"
                        "paginaInicial" => "46"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical features and hormonal characteristics in a case of ovarian arrhenoblastoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              P Tita \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              A Spina \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              G Briguglia \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Magro \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              D Gallo \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              C Finocchiaro \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Endocrinol Investigation"
                        "fecha" => "1996"
                        "volumen" => "19"
                        "paginaInicial" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of continuous androgen secretion on the hypothalamic-pituitary axis in woman&#58; evidence from a luteinized thecoma of the ovary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              A Dunaif \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RE Scully \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RN Andersen \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              DS Chapin \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              WF Crowley Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "1984"
                        "volumen" => "59"
                        "paginaInicial" => "93"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1210&#47;jcem-59-3-389"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inhibin as a marker for granulosa-cell tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              RE Lapp&#246;hn \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              HG Burger \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              J Bouma \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              M Bangah \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              M Krans \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              HW de Bruijn \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1989"
                        "volumen" => "321"
                        "paginaInicial" => "3"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Androgen modulation of luteinizing hormone secretion by female rat gonadotropes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              JL Turgeon \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              DW Waring \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Endocrinology"
                        "fecha" => "1999"
                        "volumen" => "140"
                        "paginaInicial" => "74"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1210&#47;en&#46;140&#46;4&#46;1767"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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ISSN: 18075932
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es en pt

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