Abstract
BackgroundOvarian hyperstimulation caused by follicle-stimulating hormone-secreting gonadotroph cell adenoma is a rare, with a few reported cases, but almost certainly unnoticed cases occur because of the absence of detailed examinations. We retrospectively reviewed 200 patients treated for gonadotroph cell adenoma in our institute and identified 26 women of reproductive age. Two of these 26 patients had a history of ovarian cysts. One patient was considered to have had typical ovarian hyperstimulation, successfully treated by transsphenoidal surgery. The other patient initially underwent transsphenoidal surgery because of visual disturbance, but endocrinological examinations suggested possible relationships with previous ovarian hyperstimulation. We present the former case and discuss the latent risk of failure to identify this entity.Case presentationA 36-year-old woman with a sellar tumor was referred to our hospital with suspected ovarian hyperstimulation. She had a history of repeated surgery for ovarian cysts. Serum follicle-stimulating hormone and estradiol levels were within the normal ranges, and only the luteinizing hormone level was suppressed significantly. Transsphenoidal surgery achieved gross total tumor removal, and the histological diagnosis was follicle-stimulating hormone-secreting gonadotroph cell adenoma. The serum follicle-stimulating hormone, luteinizing hormone, and estradiol levels returned to the normal ranges postoperatively, and the ovarian cysts subsequently decreased in size without particular interventions.ConclusionOvarian hyperstimulation could regress after resolving the causes of high follicle-stimulating hormone level, so avoiding unnecessary ovary surgery. Detailed endocrinological examination including estradiol evaluation with pituitary imaging is quite important in women of reproductive age to establish the correct diagnosis.
Highlights
Ovarian hyperstimulation caused by follicle-stimulating hormone-secreting gonadotroph cell adenoma is a rare, with a few reported cases, but almost certainly unnoticed cases occur because of the absence of detailed examinations
Detailed endocrinological examination including estradiol evaluation with pituitary imaging is quite important in women of reproductive age to establish the correct diagnosis
Ovarian hyperstimulation induced by inappropriate Follicle-stimulating hormone (FSH) oversecretion from adenoma cells may manifest as multiple ovarian cysts, FSHsecreting gonadotroph cell adenoma is rare as the cause of multiple ovarian cysts [3]
Summary
The present case of FSH-secreting gonadotroph cell adenoma was the cause of recurrent ovarian cysts. We emphasize the importance of pituitary imaging and detailed endocrinological examinations as well as careful evaluation of the gynecological history in women of reproductive age to avoid unnecessary ovary surgery. Ethics The therapeutic protocol was approved by the internal ethics committee of Kohnan Hospital 2012. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. Authors’ contributions TK analyzed the patient data regarding the endocrinological outcome, and was a major contributor in writing the manuscript. All authors read and approved the final manuscript. Author details 1Department of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachi Minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan. Author details 1Department of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachi Minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan. 2Department of Neurosurgery, Yonezawa City Hospital, Yonezawa, Yamagata, Japan. 3Deparment of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan. 4Deparment of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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