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.
Agha-Hosseini
Marzieh
M
Infertility Center of Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Aleyaseen
Ashraf
A
Safdarian
Leili
L
Kashani
Ladan
L
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