OBJECTIVE: To describe the clinical symptoms associated with the diagnosis of pituitary gonadotroph adenoma in premenopausal women. DESIGN: Report of three separate cases. SETTING: University medical center. PATIENT(S): Three patients: a 31-year-old woman with primary infertility, recurrent adnexal masses, and highly elevated estradiol level; a 30-year-old woman with recurrent multicystic ovaries following multiple cystectomies and transvaginal cyst aspirations, and elevated estradiol level; a 43-year-old woman with bilateral complex cystic adnexal masses and an elevated estradiol level, who underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a suspected granulosa cell tumor. INTERVENTION(S): Transsphenoidal resection of a pituitary mass. MAIN OUTCOME MEASURE(S): Serum estradiol, FSH, and LH levels; transvaginal ultrasonography of the ovaries; histologic examination of pituitary tumors. RESULT(S): Transsphenoidal resection of pituitary adenomas resulted in normalization of serum estradiol and FSH levels and resolution of adnexal masses in two of the women. CONCLUSION(S): Pituitary gonadotroph adenoma must be considered in the differential diagnosis in reproductive-aged women presenting with the clinical symptom triad of new onset oligomenorrhea, bilateral cystic adnexal masses, and elevated estradiol and FSH levels with suppressed levels of LH; timely diagnosis may prevent unnecessary and potentially damaging surgical procedures.
OBJECTIVE: To describe the clinical symptoms associated with the diagnosis of pituitary gonadotroph adenoma in premenopausal women. DESIGN: Report of three separate cases. SETTING: University medical center. PATIENT(S): Three patients: a 31-year-old woman with primary infertility, recurrent adnexal masses, and highly elevated estradiol level; a 30-year-old woman with recurrent multicystic ovaries following multiple cystectomies and transvaginal cyst aspirations, and elevated estradiol level; a 43-year-old woman with bilateral complex cystic adnexal masses and an elevated estradiol level, who underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a suspected granulosa cell tumor. INTERVENTION(S): Transsphenoidal resection of a pituitary mass. MAIN OUTCOME MEASURE(S): Serum estradiol, FSH, and LH levels; transvaginal ultrasonography of the ovaries; histologic examination of pituitary tumors. RESULT(S): Transsphenoidal resection of pituitary adenomas resulted in normalization of serum estradiol and FSH levels and resolution of adnexal masses in two of the women. CONCLUSION(S): Pituitary gonadotroph adenoma must be considered in the differential diagnosis in reproductive-aged women presenting with the clinical symptom triad of new onset oligomenorrhea, bilateral cystic adnexal masses, and elevated estradiol and FSH levels with suppressed levels of LH; timely diagnosis may prevent unnecessary and potentially damaging surgical procedures.
Authors: David J Cote; Timothy R Smith; Courtney N Sandler; Tina Gupta; Tejus A Bale; Wenya Linda Bi; Ian F Dunn; Umberto De Girolami; Whitney W Woodmansee; Ursula B Kaiser; Edward R Laws Journal: Neurosurgery Date: 2016-12 Impact factor: 4.654