Report Sebum Measurements for Rapid Identification of Hyperandrogenism Due to an Ovarian Leydig Cell Tumor Abraham ZIotogorski, M.D., Benjamin Glaser, M.D., Bruno Bercovici, M.D., and Shabtay Dikstein, Ph.D. Abstract: Direct measurements of sebum with the Sebumeter were used in a patient with a benign androgen-producing tumor of the ovary. Androgen levels fell immediately after sur- gery, whereas the markedly elevated sebum levels found pre- operatively dropped to normal after a delay of more than 2 weeks. Therefore, the Subumeter, due to its simplicity, may be useful for the preliminary screening and follow-up of patients with hyperandrogenic states. The clinical use of sebum measurements in the diag- nosis and follow-up of hyperandrogenic states has not been widely accepted since the standard method for measuring sebum secretion is complex and time-con- suming. We describe a patient with a rare type of an- drogen-secreting tumor, where direct measurements of sebum using the Sebumeter proved to be a rapid and convenient method in the diagnosis and follow-up. Sebum Measurements Measurements were made with a Sebumeter (Courage & KJiazaka Electronic Co., Cologne, Germany), which consists of a cassette containing a continuous roll of plastic film and a small box with a photometer. This film, when applied to the skin, absorbs the sebum in 30 seconds, thereby, changing its transparency. The trans- parency change is measured by a photometer, embed- ded in the box, and the measurement is translated au- tomatically and immediately into sebum concentra- From the Departments of Dermatology, Endocrinology and Me- tabolism, and Gynecology, Hadassah University Hospital, Jerusa- lem, and the Unit of Cell Pharmacology, School of Pharmacy, He- brew University, Jerusalem, Israel. Address correspondence to; Abraham ZIotogorski, M.D., Depart- ment of Dermatology, Hadassah University Hospital, Kiryat Ha- dassah, P.O. Box 12000, Jerusalem 91120, Israel. tion expressed as micrograms per square centimeter. The entire procedure takes less than 1 minute. Mea- surements were taken at 11:00 a.m. from three points on the forehead, the first in the midline one centimeter above the nasion and the other two immediately to the right and left of the first point. The sebum level re- ported is the mean of these three measurements. Spe- cial care was taken that 12 hours prior to measure- ments no cosmetic was applied to the skin and that the forehead had not been washed. The patient's husband served as a control to document the reproducibility of the method. Case Report • A 68-year-old woman was referred to the Department of Endocrinology with the chief complaint of excessive fa- cial and body hair growth over the previous 12 months. Initial evaluation revealed marked elevation of testos- terone and A-4 androstenedione with normal dehydro- epiandrosterone-sulfate (DHEA-S) (Table 1). Moderate enlargement of the right ovary was documented on computed tomography and ultrasound scan (right ovary 33X31X25 mm, left ovary 23X21X15 mm). Patho- logical uptake of selenium cholesterol (Scintidren, Amershan, UK) was seen in the region of the right ovary. Skin surface sebum levels prior to surgery were 251-273 /ig/cm^, well above the range seen in post- menopausal control subjects (n = 37, mean + SEM, 95 ± 10; median, 78; range, 34-178). At surgery, the tumor was located on the right ovary and bilateral ovariectomy was performed. Histoiogical examination confirmed a benign Leydig cell tumor. Testosterone and A-4 andro- stenedione returned to normal one day post-operation while DHEA-S levels remained relatively unchanged (Table 1). The high sebum levels persisted and returned to normal values (around 90 yitg/cm^) only between the 16th and 23rd postoperative days and remained at this level through the following 2 months. The husband's skin surface forehead sebum levels fluctuated between 195-233 /ug/cm^, levels appropriate for a man of his age. 276 April 1991, Vol. 30, No. 4