OHT - aberrant proliferation of hyperplastic luteinised theca cells within ovarian stroma outside usual lucation in follicle wall
Theca cells express LH receptors - stimulated by LH to produce T. High LH levels after menopause results in high T production
Androgens normallytransferred to granulosa cells & converted to E2 via aromatase
OHT - theca cells located in stroma - released into circulation & not aromatised.  High menopausal LH results in high androgen levels
R ovarian V difficult to cannulate - drains directly into IVC at acute angle - small, spasm prone, exit valves
46% success on R in one series of 38 pts
Immunoassays - large volumes for multiple assays, cross-reaction of similar molecules. LCMS able to measure 15 steroids in 0.2ml sample

Conclusions:
Hyperandrogenic syndromes need to be investigated if rapidly progressive or atypical features present
Testosterone levels above the normal female range need to be investigated for serious underlying cause
First reported use of pure GnRH antagonist in ovarian hyperthecosis
Duration of response in OHT vastly exceeds elimination of Degarelix in OHT but not ovarian tumour, despite rise in LH and FSH in OHT
Multitude of steroids may be produced in hyperandrogenic states and are  likely to give unexpected clinical presentations

Acknowledge David Handelsman, ANZAC Research Institute, Sydney, plus others involved in preparing presenation (maybe verbally Louise Goodall for title)