title: A functioning FSH-secreting pituitary macroadenoma causing an ovarian hyperstimulation syndrome with multiple cysts resected and relapsed after leuprolide in a reproductive-aged woman.
abstract: Bioactive gonadotropin-secreting pituitary adenomas are very rare in fertile women and can cause an ovarian hyperstimulation syndrome (OHSS). A 31-year-old woman with oligo-amenorrhea, severe ovarian cystic swelling and high serum estradiol was submitted to the resection of ovarian cysts and then treated with long-acting leuprolide 11.25 mg. Two months later, the ovarian multicystic hyperplasia relapsed, thus a pituitary MRI was performed and a pituitary macroadenoma was detected. In January 2010, she was referred to our Endocrinology Department where her hormonal evaluation showed high serum estradiol, FSH, α-subunit and inhibin with low LH. In April 2010, she underwent a trans-sphenoidal pituitary adenomectomy, which rapidly regularized the hormonal profile, the ovary and pituitary morphology and the menses. The case presented confirms that gonadotrophinomas occurring in reproductive-aged women frequently produce symptoms of ovarian hyperstimulation and proves that the use of GnRH analogs is not indicated in this condition.
authors.affiliation: Department of Endocrinology, University of Pisa, Pisa, Italy. enrico.macchia@med.unipi.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Macchia
authors.forename: Tommaso
authors.initials: T
authors.lastname: Simoncini
authors.forename: Valentina
authors.initials: V
authors.lastname: Raffaelli
authors.forename: Martina
authors.initials: M
authors.lastname: Lombardi
authors.forename: Aldo
authors.initials: A
authors.lastname: Iannelli
authors.forename: Enio
authors.initials: E
authors.lastname: Martino
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D000328:Adult; D000367:Age Factors; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects / Q000627:therapeutic use; D005640:Follicle Stimulating Hormone / Q000378:metabolism* / Q000502:physiology; D006801:Humans; D016729:Leuprolide / Q000009:adverse effects / Q000627:therapeutic use*; D010048:Ovarian Cysts / Q000150:complications / Q000601:surgery*; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced / Q000150:complications / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D012008:Recurrence; D012098:Reproduction / Q000502:physiology; D017211:Treatment Failure
chemical_list: D005300:Fertility Agents, Female; D005640:Follicle Stimulating Hormone; D016729:Leuprolide