Successful pregnancy after bromocriptine therapy in an anovulatory woman complicated with ovarian hyperstimulation caused by follicle-stimulating hormone-producing plurihormonal pituitary microadenoma.
Gonadotropin-producing pituitary adenomas are extremely rare in reproductive-age women. We report here a case of gonadotroph microadenoma with ovarian hyperstimulation. It was found in a 29-yr-old infertile Japanese woman with enlarged multicystic ovaries. The patient had an elevated basal serum estradiol level (up to 6755 pM, or 1840 pg/ml). Serum FSH and prolactin were mildly elevated (15.4 IU/liter, 1.4 nM or 31.4 ng/ml), whereas LH was low (0.5 IU/liter). The FSH level was paradoxically elevated in response to TRH administration. Dynamic magnetic resonance imaging revealed a pituitary microadenoma. Daily administration of bromocriptine, a dopamine agonist, normalized the ovarian size, and the patient ovulated naturally. She conceived after 3 months of bromocriptine therapy and delivered a normal child. She underwent elective transsphenoidal pituitary surgery, 3 yr after the delivery. Immunostaining of the resected tumor showed that 80% and less than 5% of the tumor cells stained for FSH-beta and prolactin, respectively. Furthermore, RT-PCR suggested that dopamine type 2 receptor was expressed in the adenoma. Gonadotroph microadenoma should be considered in women with spontaneous ovarian hyperstimulation, even if they have no neurological symptoms or marked pituitary enlargement. In such cases, bromocriptine therapy may be an alternative to pituitary surgery.
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
Yasutaka
Y
Murata
Hisao
H
Ando
Tetsuro
T
Nagasaka
Ikuo
I
Takahashi
Kiyoshi
K
Saito
Hiroyuki
H
Fukugaki
Katsuji
K
Matsuzawa
Shigehiko
S
Mizutani
D000236:Adenoma / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D000328:Adult; D000858:Anovulation / Q000209:etiology; D001971:Bromocriptine / Q000627:therapeutic use*; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000032:analysis / Q000096:biosynthesis / Q000097:blood; D037201:Follicle Stimulating Hormone, beta Subunit / Q000032:analysis; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D011247:Pregnancy; D011388:Prolactin / Q000032:analysis; D012333:RNA, Messenger / Q000032:analysis; D017448:Receptors, Dopamine D2 / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed
D037201:Follicle Stimulating Hormone, beta Subunit; D012333:RNA, Messenger; D017448:Receptors, Dopamine D2; D001971:Bromocriptine; D004958:Estradiol; D011388:Prolactin; D005640:Follicle Stimulating Hormone