Secondary amenorrhea with low serum luteinizing hormone and follicle-stimulating hormone caused by an inhibin A- and inhibin B-producing granulosa cell tumor.
OBJECTIVE
Here, we report a case of secondary amenorrhea with low serum luteinizing hormone and follicle-stimulating hormone levels due to an inhibin A- and inhibin B-producing granulosa cell tumor of the ovary.


METHODS
A woman aged 26 with infertility, secondary amenorrhea and low levels of gonadotropin was referred to us as a case of hypothalamic amenorrhea. There was a mass measuring 56 x 41 mm in her right adnexa. We were suspicious of malignancy and checked the tumor marker levels. Laboratory findings showed high levels of inhibin A and B. She underwent an exploratory laparotomy. Microscopic examination revealed an adult granulosa cell tumor. Eighteen days after excision, she had spontaneous menstruation with normal levels of follicle-stimulating hormone and luteinizing hormone.


CONCLUSIONS
A granulosa cell tumor secretes inhibin A and B, which suppress follicle-stimulating hormone and luteinizing hormone release through a central mechanism. This leads to amenorrhea, which can be misdiagnosed as hypothalamic amenorrhea. Inhibin producing ovarian tumors must be considered in the assessment of patients with apparent hypothalamic amenorrhea.
Infertility Center of Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Marzieh
M
Agha-Hosseini
Ashraf
A
Aleyaseen
Leili
L
Safdarian
Ladan
L
Kashani
D000328:Adult; D000568:Amenorrhea / Q000097:blood* / Q000209:etiology*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006106:Granulosa Cell Tumor / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D007265:Inhibins / Q000378:metabolism*; D007986:Luteinizing Hormone / Q000097:blood; D010051:Ovarian Neoplasms / Q000150:complications / Q000378:metabolism* / Q000473:pathology
C422362:inhibin A; C422364:inhibin B; D007265:Inhibins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone