Isolated FSH deficiency revealing a granulosa cell tumor.
We report a case of a 41-year-old woman with a recent secondary amenorrhea and infertility. The initial assessment ruled out premature ovarian failure, polycystic ovary syndrome and led to suspect a hypothalamo-pituitary cause. However, the unusual hormone pattern with a very low level of FSH, normal levels of LH and estradiol, associated with a positive progesterone test suggested the presence of a FSH inhibiting factor: the unexpectedly high levels of inhibin B and AMH were suggestive of a granulosa cell tumor as showed by the radiologic findings. This prompted a surgical exploration, which confirmed the putative diagnosis. This case report illustrates the inhibin B and AMH values and the modern-day pelvic imaging data encountered in menstrual irregularities caused by a granulosa cell tumor.
Hôpital Robert-Debré, CHU de Reims, France. bdecoudier@chu-reims.fr
B
B
Decoudier
A-C
AC
Hécart
C
C
Hoeffel
O
O
Graesslin
K
K
Joseph
F
F
Amiot-Chapoutot
B
B
Delemer
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood / Q000172:deficiency*; D007987:Gonadotropin-Releasing Hormone / Q000378:metabolism; D006062:Gonadotropins / Q000097:blood / Q000378:metabolism; D006106:Granulosa Cell Tumor / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D007986:Luteinizing Hormone / Q000097:blood; D008279:Magnetic Resonance Imaging; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010053:Ovary / Q000473:pathology; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography
D000970:Antineoplastic Agents; D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone