title: Ovarian hyperstimulation caused by gonadotroph cell adenoma: a case report and review of the literature.
abstract: OBJECTIVE
  We present a case of spontaneous ovarian hyperstimulation caused by pituitary gonadotroph macroadenoma, and include a review of the literature.
  
  
  METHODS
  A 27-year-old woman presented with irregular menstruation and bilateral multicystic enlargement of the ovaries. Serum estradiol (E(2)) levels were marginally elevated for the follicular phase but within the physiological range. Serum luteinizing hormone (LH) was extremely low, follicle-stimulating hormone (FSH) was normal, and prolactin (PRL) was high. Magnetic resonance imaging disclosed a pituitary macroadenoma. Immunohistochemical examination of the surgically removed adenoma showed intense reactivity for FSH and LH. After the operation, E(2), LH and PRL levels were normalized, the ovaries returned to a normal morphology, and regular menstrual cycles were resumed.
  
  
  CONCLUSIONS
  A review of the literature showed that ovarian hyperstimulation caused by pituitary gonadotroph adenoma is not always accompanied by elevated FSH levels. High PRL and E(2) and low LH were reported in the majority of the cases, but E(2) may stay within the range observed in normal menstrual cycles.
authors.affiliation: Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan. mkihara@restaff.chiba-u.jp
authors.forename: Maki
authors.initials: M
authors.lastname: Kihara
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Sugita
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Nagai
authors.forename: Naokatsu
authors.initials: N
authors.lastname: Saeki
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tatsuno
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Seki
mesh_terms: D000236:Adenoma / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D000328:Adult; D005260:Female; D005640:Follicle Stimulating Hormone / Q000096:biosynthesis* / Q000097:blood; D006801:Humans; D007150:Immunohistochemistry; D007986:Luteinizing Hormone / Q000096:biosynthesis* / Q000097:blood; D008279:Magnetic Resonance Imaging; D008599:Menstruation Disturbances / Q000209:etiology; D010049:Ovarian Diseases / Q000209:etiology* / Q000628:therapy; D010911:Pituitary Neoplasms / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D011388:Prolactin / Q000097:blood
chemical_list: D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone