Size Of Ovarian Cysts Research Articles

Constructing predictive models for vaginal surgery in patients with noninvasive gynecological conditions.

To develop predictive models for vaginal operative route selection based on clinical variables that can be easily assessed preoperatively in patients with noninvasive gynecological conditions. Retrospective study. University Hospital. Women with routine gynecological surgeries via different approaches. The medical records of 315 women without prolapse and undergoing hysterectomy, adnexal cystectomy or myomectomy were reviewed. Multiple logistic regression analysis was used to identify factors associated with the vaginal approach for each procedure. Predictive models were generated and optimal cut-off points were identified using the receiver operating characteristic curve. Predictive models for different vaginal surgical procedures. For hysterectomy, the patient's body mass index, dysmenorrheal complaints and uterine size were identified as negative predictors for vaginal hysterectomy, whereas previous vaginal delivery was positive. For adnexal cystectomy, adnexal pathology was a negative predictor, whereas previous vaginal delivery and ovarian cyst size were positive. For myomectomy, the body mass index and number of fibroids were negative predictors while previous vaginal delivery was positive. All three models were able to predict the vaginal procedures undergone by women and the areas under the curve were 0.88, 0.95 and 0.92, respectively. Each optimal model cut-off value (logit(p)=0.53, 0.36, 0.73) resulted in good sensitivity (92.3%, 100% and 87.5%, respectively) and specificity (77.8%, 88.6% and 90.9%, respectively). These predictive models, which used clinical variables that can be easily assessed preoperatively, may help surgeons to select candidates for different vaginal procedures.

Impact of intracystic ethanol instillation on ovarian cyst diameter and adjacent ovarian tissue

ObjectiveTo investigate the regression level of simple ovarian cyst size after local ethanol application and the damage level of adjacent ovarian reserve in rats. Study designThis study was conducted at Firat University Animal Laboratory with 18 mature (12–14 weeks old) female Wistar albino rats weighing 200–220g, with regular cycles. Ovarian cyst induction was performed with unilateral salpingectomy. Fourteen rats with ovarian cysts after a second laparotomy were divided into two groups as follows: Group 1 (n=7): cyst aspiration group, and Group 2 (n=7): intracystic 95% ethanol application group. One month after the cyst aspiration procedure a third laparotomy was performed. The cyst number and size were recorded for each rat. Right ovariectomy was performed and formalin-fixed/paraffin-embedded tissues were sectioned at 5μm thickness. Under light microscopy, ovarian total follicle reserve and fibrosis were evaluated with Masson trichrome staining and apoptosis was evaluated with TUNEL staining. The groups were compared with the Mann–Whitney U test and Wilcoxon Rank test. p<0.05 was considered significant. ResultsOvarian cyst formation was observed in 85% (15/18) of rats. The mean diameter of ovarian cysts in Groups 1 and 2 were, respectively, 10.3mm and 10.1mm. After aspiration, there was no significant reduction in the cyst diameter (10.3mm vs 8.1mm), but after ethanol application the diameter significantly reduced (10.1mm vs 3.4mm, p<0.05). Mean ovarian follicle count in Group 2 was significantly lower than in Group 1 (25 vs 42, p<0.05), and mean fibrosis and apoptosis scores in Group 2 were significantly higher than in Group 1 (2.5 vs 0.9, p<0.05). ConclusionLocal ethanol application reduces cyst diameter but concomitantly decreases ovarian reserve due to increased fibrosis in rats. In humans, intracystic ethanol application should be performed cautiously.

Decreased expression of pigment epithelium-derived factor and increased microvascular density in ovarian endometriotic lesions in women with endometriosis

To determine whether women with endometriosis have altered expression of pigment epithelium-derived factor (PEDF) in ovarian endometriotic lesions as compared to women without endometriosis. Ectopic and eutopic and normal endometrial tissues were sampled from 40 women with ovarian endometriosis and 20 control women, respectively. Endometrial PEDF expression and microvascular density (MVD) using an antibody to von Willebrand factor (vWF) and alpha-smooth muscle actin (α-SMA) were evaluated by using immunohistochemical staining. We detected decreased PEDF expression and increased MVD using anti-vWF and -α-SMA in ovarian endometriotic lesions in women with endometriosis compared with the control group. In women with endometriosis, the MVD using anti-vWF and -α-SMA but not PEDF expression in ovarian endometriotic lesions correlated with the size of ovarian endometriotic cysts and the severity of the disease. Moreover, the MVD using anti-vWF was negatively correlated with PEDF expression in control endometrium but not in ovarian endometriotic lesions. Our results suggest that decreased PEDF expression and increased MVD in ovarian endometriotic lesions might play an important role in the pathogenesis of ovarian endometriosis.

Evaluation of levonorgestrel-releasing intrauterine system in treatment of recurrent endometriosis after conservative surgery

To evaluate the efficiency of levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment. Twenty-three patients with recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment were treated by LNG-IUS. All patients rejected further operation and had no desire of fertility. The visual analogue scale (VAS) scores of pain, menstrual model, weight and serum CA125 level and the volume of ovarian endometriotic cysts before and after 3, 6, 12, 24 and 36 months of treatment were recorded and compared. (1) VAS score:after 12 months of using LNG-IUS, dysmenorrheal, chronic pelvic pain or dyspareunia were relieved significantly. VAS score were dropped from 5.9±2.3, 4.3±2.0 to 1.0±0.7, 1.4±1.1 (P<0.01). (2) Volum of cysts:after 6 months of using LNG-IUS, the volume of recurrent ovarian endometriotic cysts in 11 patients were reduced from (11.4±6.1) cm3 to (5.5±3.4) cm3 significantly (P<0.01). At 12 months of follow-up, it suggested that 2 patients' ovarian endometriotic cysts disappeared. At 24 months follow-up, 9 patients ovarian endometriotic cysts disappeared (3) CA125: serum CA125 decreased from (65.5±19.6) kU/L to (42.1±13.6) kU/L at 6 months after treatment remarkably (P<0.01). Continued to decrease after 12 months and then become steady. Irregular bleeding and spotting was the main side effects, weight gain was also observed in few patients. LNG-IUS could be used in treatment of recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment effectively. It could relieve pain, reduce the level of CA125 and decrease the size of ovarian endometriotic cysts. LNG-IUS seems to be an effective, safe, and long term treatment for endometriosis with fewer side effects and better compliance.

Evidence based clinical study on the effect of homoeopathic medicines in cases of ovarian cysts

Background and Objectives: Patients with persistent ovarian cyst for more than 6 months which do not respond to hormone therapy usually, require surgical treatment. Surgery should be avoided as much as possible in unmarried and childless women where future reproductive functions are of prime concern. There are a few claims by homoeopathic physicians to have treated cases of ovarian cysts with homoeopathic medicines. Such claims, however, have neither been scientifically documented nor published. To give scientific support to such sporadic claims, a clinical study was carried out to evaluate the usefulness of homoeopathic medicines for treatment of patients suffering from ovarian cyst. Methods: A total of 73 patients suffering from ovarian cysts were enrolled, as per inclusion criteria out of which 48 completed the study according to protocol. Medicines selected on the basis of principles of homoeopathy were prescribed and changes in the size of ovarian cysts were assessed at the end of 1 year on the basis of pre and post treatment ultrasonography reports and hormonal tests. Results: After comparing pre and post treatment ultrasonography reports, the difference in mean values of maximum dimension of ovarian cyst was found to be statistically significant (p value < 0.05). Cyst was totally resolved in 8 (16.67%) patients, 10 (20.83%) patients had reduction in the size of the cysts, 21 (43.75%) patients remained status quo while 9 (18.75%) did not improve. Natrum muriaticum (n=7), Pulsatilla (n= 3), Sepia (n=3) and Calcarea carbonicum (n= 2) were found to be most useful homoeopathic medicines. Conclusion: The preliminary results obtained from this observational study are encouraging. The study indicates the positive role of Homoeopathic therapy in the management of ovarian cysts. Such study with bigger sample size through randomized controlled trial is needed for further validation.

Bazedoxifene, a selective estrogen receptor modulator

The aim of this study was to evaluate the endometrial, ovarian, and breast safety of bazedoxifene used as a treatment for postmenopausal osteoporosis. Healthy women (aged 55-85 y) with osteoporosis were enrolled in a randomized, double-blind, placebo-controlled phase 3 trial. Participants were randomized to treatment with bazedoxifene 20 or 40 mg, raloxifene 60 mg, or placebo daily for 3 years. Endometrial and ovarian safety was assessed by periodic transvaginal ultrasonography and endometrial biopsy through 24 months. Gynecologic and breast-related adverse events were recorded throughout the study. Among 753 participants with available transvaginal ultrasonography data, there were no significant between-group differences in overall endometrial thickness or in the percentage of participants with endometrial thickness greater than 5 mm at 12 or 24 months. Changes in the mean endometrial thickness (+/-SE) from baseline were -0.07 +/- 0.11 mm (bazedoxifene 20 mg), 0.10 +/- 0.11 mm (bazedoxifene 40 mg), 0.16 +/- 0.12 mm (raloxifene 60 mg), and -0.08 +/- 0.11 mm (placebo) at 24 months. There was one report of endometrial hyperplasia in each group, and there were zero, two, two, and three reports of endometrial carcinoma with bazedoxifene 20 and 40 mg, raloxifene 60 mg, and placebo, respectively. There were no clinically important changes from baseline in the number or size of ovarian cysts among groups. There was a significantly lower incidence of fibrocystic breast disease (P <or= 0.05) with bazedoxifene compared with raloxifene 60 mg. Bazedoxifene was associated with a favorable endometrial, ovarian, and breast safety profile in postmenopausal women with osteoporosis.

Bazedoxifene effects on the reproductive tract in postmenopausal women at risk for osteoporosis

The aim of this study was to examine the endometrial, ovarian, and breast safety of bazedoxifene, a novel selective estrogen-receptor modulator, in postmenopausal women at risk for osteoporosis. Healthy postmenopausal women (N = 1,583; mean age, 57.6 y) with lumbar spine or femoral neck bone mineral density T scores between -1 and -2.5 and/or other clinical risk factors for osteoporosis were enrolled in a 24-month, phase 3, randomized, double-blind, placebo- and active-controlled trial. They received daily treatment with bazedoxifene 10, 20, or 40 mg; placebo; or raloxifene 60 mg. Reproductive safety assessments included periodic transvaginal ultrasound measurements of endometrial thickness, ovarian volume, and presence of ovarian cysts; periodic endometrial biopsies; and adverse event reporting. Bazedoxifene was not associated with a significant change from baseline in mean endometrial thickness at month 24. The percentage of participants with a change from baseline in endometrial thickness or endometrial thickness greater than 5 mm at month 24 was similar among groups. There was no consensus diagnosis of endometrial hyperplasia or malignancy in the bazedoxifene or raloxifene groups; the rates of other histologic findings, including endometrial polyps, were low (<5%) and similar among groups. No significant between-group differences were found in the change from baseline in ovarian volume, number or size of ovarian cysts, or incidence of ovarian cancer. Reports of breast pain (<4%) and breast cancer (<1%) were low and evenly distributed among groups. A favorable endometrial, ovarian, and breast safety profile was found after 2 years of treatment with bazedoxifene in healthy, recently postmenopausal women at risk for osteoporosis.

O908 Comparison of screening performance of menopausal status, ultrasound morphology of the cyst, CA 125 >30 U/ml, ovarian cyst size of 5 cm and risk of malignancy index (RMI) of 250 and 200 in predicting ovarian cancer

O908 Comparison of screening performance of menopausal status, ultrasound morphology of the cyst, CA 125 >30 U/ml, ovarian cyst size of 5 cm and risk of malignancy index (RMI) of 250 and 200 in predicting ovarian cancer

Giant Ovarian Cysts: Is the Primary Laparotomy Still a Gold Standard?

Study Objective: Despite the development of laparoscopic surgery, the management of giant ovarian cysts is still mainly performed by laparotomy, probably for two reasons. Firstly, it is difficult to manipulate giant cysts in laparoscopy. Secondly, there is always the worry that it may be malignant. Our aim is to show that the large size of ovarian cysts is not an obstacle to laparoscopic management.

Endometrial and ovarian safety of bazedoxifene (BZA) in the prevention of postmenopausal osteoporosis

Endometrial safety is a key concern with selective estrogen receptor modulators (SERMs). BZA is a novel SERM that showed no significant uterotropic effects in preclinical and small clinical studies. This study assessed the efficacy and endometrial/ovarian safety of BZA for the prevention of osteoporosis. A randomized, double-blind, placebo- and raloxifene (RLX)-controlled phase III clinical trial conducted at 101 sites in the United States and globally. Generally healthy, postmenopausal (≥1 year) women ≥45 years of age were randomized to receive BZA 10, 20, or 40 mg; RLX 60 mg; or placebo daily for 2 years. Exclusion criteria included endometrial hyperplasia or endometrial thickness >5 mm. The primary efficacy endpoint was change from baseline in lumbar spine (LS) bone mineral density (BMD) at 24 months. Endometrial and ovarian safety were evaluated based on double-wall endometrial thickness and ovarian volume assessed by transvaginal ultrasound (TVUS) at Months 6, 12, 18, and 24, and endometrial biopsies performed at Months 12 and 24. The presence of, or changes in, ovarian cysts compared to baseline was assessed. Of the 1583 women (mean age ± standard deviation [SE], 57.6 ± 6.5 years) who received ≥1 dose of study medication, 1014 (70.7%) had an intact uterus, and 963 (60.8%) had TVUS at baseline and ≥1 on-therapy timepoint. LS BMD was preserved with BZA 10, 20 and 40 mg relative to placebo (P<0.001). Endometrial thickness with BZA 10, 20, and 40 mg remained stable over 24 months (mean change from baseline [mm] ± SE, 0.05 ± 0.11, −0.01 ± 0.10, and −0.16 ± 0.11, respectively), and was not different from baseline, placebo (−0.23 ± 0.10 mm), or RLX (−0.05 ± 0.11). There were no cases of endometrial hyperplasia or malignancy with any dose of BZA (n = 414) or RLX (n = 147), and 1 case of endometrial malignancy with placebo (n = 139). The incidence of endometrial polyps at 24 months was similar among BZA 10, 20, and 40 mg (2.2%, 3.4%, and 2.3%, respectively), and not different from placebo (3.5%); a slightly higher incidence of polyps was reported with RLX (4.7%). There were no clinically important changes from baseline or differences between treatment groups in the number or size of ovarian cysts or ovarian volume. BZA exhibits an excellent endometrial and ovarian safety profile, preserves BMD, and is an important addition to the therapeutic armamentarium for the prevention of postmenopausal osteoporosis.

Basal Ovarian Cysts and Clomiphene Citrate Ovulation Induction Cycles

To evaluate the effect of simple basal ovarian cysts in patients undergoing infertility treatment with clomiphene citrate. To evaluate the effect of clomiphene citrate on pretreatment simple ovarian cysts. Prospective cohort trial of 84 infertility patients undergoing ovulation induction with clomiphene citrate. Patients with basal ovarian cysts of 10 mm or greater (n = 42) were compared with patients without ovarian cysts (n = 42). The main outcome measure was ovulation determined by menstrual cycle day 21 progesterone level. Each patients with an ovarian cyst was also evaluated for persistence or resolution of the cyst in association with ovulation and cyst size. Pretreatment and posttreatment transvaginal ultrasound examinations were performed on all patients. Demographic data were similar among the groups. The mean ovarian cyst size was 17.4 +/- 5.8 mm. Patients in the ovarian cyst group were significantly less likely to ovulate (80.9% versus 97.6%, P < .05), but did not differ in pregnancy rate compared with patients without baseline ovarian cysts (4.8% versus 11.9%, P = .43). Persistent ovarian cysts occurred in 36.7% of the patients. The initial size of the cyst did not predict cyst persistence. According to these data, basal ovarian cysts significantly reduce ovulatory events in patients treated with clomiphene citrate. II-2.

P157: Prenatal diagnosis of ovarian cyst

Fetal ovarian cysts, previously rarely reported, are being diagnosed with increasing frequency with wider utilization of obstetrical ultrasonography. The authors report a case of a 38-year-old woman, presenting in the routine sonogram at 32 weeks a fetal abdominal cyst. The ultrasonography revealed a female fetus with a rightsided thin walled multilocular cyst, separate from the stomach and bladder, measuring 5.2 × 4.3 × 4.8 cm. Amniotic fluid volume was normal. Serial sonograms obtained weekly showed no change in the size of the cyst and adequate fetal growth for gestational age. The patient was delivered by cesarean, because of a severe preeclampsia, at 37 weeks’ gestation of a 3000 g female neonate with Apgar scores of 7 and 10 at 1 and 5 minutes, respectively. The follow-up sonogram 2 weeks after birth revealed a 6 × 5.6 × 4 cm complex right adnexal cystic mass. The infant is waiting for surgery. Ovarian and genital abnormalities make up 20 per cent of all newborn abdominal masses. Fetal ovarian cysts are usually diagnosed in the third trimester as unilateral masses. Average ovarian cyst size is 5 × 5 cm at diagnosis, and size does not change throughout the pregnancy. Cesarean delivery should be reserved for obstetrical indications only, like our case. Complex masses should be operated on, and surgery must be as conservative as possible.

Consecutive Urinary Gonadotropin and Ovarian Hormone Excretory Patterns during LH-RH Analog Treatment in Female Patients with Central Precocious Puberty

To study the initial stimulative and subsequent suppressive effects of Luteinizing hormone releasing hormone analog (LHRH-a) therapy on the hypothalamic-pituitary-ovarian axis, serial urinary excretion of gonadotropin and ovarian steroids were investigated in 23 female patients with central precocious puberty. Among them, seven were treated with intranasal administration of buserelin (G1), seven with daily subcutaneous injection of buserelin (G2) and nine with subcutaneous injection of super-long-acting LHRH-a every 28 days (G3). After the initial therapy in G1, the levels of urinary gonadotropin excretion increased greatly with a high level persisting for a longer period. Responding to these increases, the levels of urinary total estrogen excretion increased to an excessively high maximum level. After the initial injection in G3, the levels of urinary gonadotropin and total estrogen excretion were augmented at the same time for a shorter period with a lesser excretion of urinary total estrogen. Ovarian cysts developed after urinary total estrogen attained a maximum and tended to grow depending on the duration and degree of high urinary total estrogen excretion.The size of ovarian cysts was greater in G1 than in G3. During therapy in all groups, the mean urinary gonadotropins were significantly suppressed compared with pretreatment. The mean urinary total estrogen excretory level during treatment in G1 was not significantly suppressed compared with before treatment, but on the other hand, with significant suppression in G3. During therapy, urinary FSH excretion increased within 24 hours of every injection of super-long-acting LHRH-a with a slight rise in LH only in all patients in G3 studied. Studies in many more patients are required because the number of subjects was limited in this study.

子宮内膜症に対するYAGレーザーバルーン蒸散法の試み

Me report a case of YAG Laser vaporization for residual endometrial ovarian cyst which had been treated by LH-RHa for 10 month.The case was 37-years-old, P (1) G (1). She consulted our hospital because of severe algomenorrhea. By pelvic examination severe tenderness of Douglas pouch and left ovarian cyst was found out and bilateral ovarian cysts were revealed by CT, echo image. Serum level of CA-125 was 56U/ML, CA19-9 was 43U/ML. She had been treated by LH-RHa for 10 month on the diagnosis of bilateral ovarian chocolate cysts and pelvic endometriosis.The size of ovarian cysts was redused and her complains of algomenorrhea was softened. But 4 month later algomenorrhea and tenderness of duoglas pouch recurred. After, successing of treatment by LH-RHa for 4 month laparoscopy was done.By findings of pelvic cavity, left ovary was enlarged as over hens egg sized and adhered to douglas pouch. This adhesion was convinced as the cause of recurred algomenorrhea. After punctation of the surfase of the left ovary and absorption of the chocolate contents, latex balloon named. VP-16 was inserted and swelled by 15ml saline solution and was oppressed to the ovarian surface. YAG laser was irradiated through the balloon by output power of 10 watts for 5 minutes. The inner surface was degenerated evenly. Me incised a part of it and confirmed degeneration by microscopy. During all these procedure there was no apparent side effects.After this procedure algomenorrhea was diminished and ovarian enlargement has not been observed.

Sonographic monitoring of pelvic organs during pubertal maturation in girls treated for childhood acute leukemia

Study Objective: To describe pubertal maturation of pelvic organs in long-term female survivors of acute childhood leukemia. Design: A case-control study comparing the uterine and ovarian biometry and the ovarian ultrasonographic patterns. Data were ordered according to age and Tanner staging. Setting: Department of Pediatrics, University of Palermo, Italy. Participants: Department of Obstetrics and Gynecology, Department of Pediatrics, University of Palermo, Italy. Subjects: 11 long-term pubertal female survivors of acute childhood leukemia. 53 healthy pubertal schoolgirls as control group. Interventions: Assessment of pubertal development by Tanner staging and by recording age at menarche. Ultrasonographic examination of uterus and ovaries. Main outcome measures: Uterine and ovarian volume calculated by the prolate ellipse formula. Ultrasonographic patterns of the ovaries. Results: Before onset of puberty, ovarian and uterine volume were smaller in long-term survivors than in controls (p < 0.05). Pubertal ovarian growth was slightly slower in long-term survivors than in controls, and pubertal uterine growth was similar. In the most mature long-term survivors, ovarian volume was significantly smaller than in controls (p < 0.05). During pubertal maturation, size and number of ovarian cysts were similar in both groups studied. Conclusion: In long-term female survivors of childhood acute leukemia, pubertal maturation of pelvic organs is normal. However, the slower ovarian growth and the smaller ovarian volume of the most mature female survivors suggests that some cytotoxic-induced ovarian damage occurred during treatment.

Management of Antenatally Diagnosed Fetal Ovarian cysts

1. Fetal ovarian cysts are usually unilateral, diagnosed in the third trimester and are uncommon. 2. Average ovarian cyst size is 5 x 5 cm at diagnosis and size does not change throughout the pregnancy. 3. Most cysts are functional in origin and histologically benign, simple cysts. 4. Polyhydramnios is a common finding but associated anomalies are rare. 5. Although large cysts can compress other viscera and torsion or rupture can occur, in utero aspiration has limited value in prenatal management. 6. Vaginal delivery with confirmed fetal pulmonary maturity or at term is appropriate. 7. Soft tissue dystocia is rare. Cesarean delivery should be reserved for obstetrical indications only. 8. The best predictor of neonatal cyst torsion risk is length of the cyst pedicle rather than cyst size. 9. When surgery is indicated a cystectomy, with preservation of maximal ovarian tissue is to be preferred over oophorectomy. 10. Ultrasound-guided aspiration of neonatal ovarian cysts may be an alternative to surgical management.

Ovarian Function in Girls with McCune-Albright Syndrome

We measured plasma estradiol levels and ovarian volumes in eight girls with precocious puberty due to McCune-Albright syndrome. Six girls had gonadotropin-independent ovarian estrogen secretion and two girls had pubertal gonadotropin levels. Mean ovarian volume in all patients was significantly greater than in normal prepubertal girls. Mean ovarian volumes of the girls with McCune-Albright syndrome overlapped the range found in girls with idiopathic central precocious puberty or central precocious puberty associated with central nervous system lesions. However, the degree of asymmetry between the right and left ovaries was significantly greater in girls with McCune-Albright syndrome. Asymmetry was due, for the most part, to the presence of large solitary cysts in the larger of the two ovaries. In the six girls with McCune-Albright syndrome and gonadotropin-independent precocious puberty, both mean ovarian volume and the degree of asymmetry between the right and left ovaries were significantly correlated with plasma estradiol. Serum follicle-stimulating hormone bioactivity was increased in two patients but did not vary with ovarian cyst size. Thyroid-stimulating hormone levels were normal but serum prolactin was slightly elevated in one of the six girls with gonadotropin-independent precocious puberty. Fluctuation in the size of unilateral ovarian cysts appears to result in changes in the plasma estradiol level, leading to advancement and spontaneous regression of secondary sexual characteristics and menses in girls with McCune-Albright syndrome. The cause of the cyst formation is unknown but may be related to periodic elevation of as yet undefined serum factors such as follicle-stimulating hormone bioactive substances.

Ovarian function in girls with McCune-Albright syndrome.

We measured plasma estradiol levels and ovarian volumes in eight girls with precocious puberty due to McCune-Albright syndrome. Six girls had gonadotropin-independent ovarian estrogen secretion and two girls had pubertal gonadotropin levels. Mean ovarian volume in all patients was significantly greater than in normal prepubertal girls. Mean ovarian volumes of the girls with McCune-Albright syndrome overlapped the range found in girls with idiopathic central precocious puberty or central precocious puberty associated with central nervous system lesions. However, the degree of asymmetry between the right and left ovaries was significantly greater in girls with McCune-Albright syndrome. Asymmetry was due, for the most part, to the presence of large solitary cysts in the larger of the two ovaries. In the six girls with McCune-Albright syndrome and gonadotropin-independent precocious puberty, both mean ovarian volume and the degree of asymmetry between the right and left ovaries were significantly correlated with plasma estradiol. Serum follicle-stimulating hormone bioactivity was increased in two patients but did not vary with ovarian cyst size. Thyroid-stimulating hormone levels were normal but serum prolactin was slightly elevated in one of the six girls with gonadotropin-independent precocious puberty. Fluctuation in the size of unilateral ovarian cysts appears to result in changes in the plasma estradiol level, leading to advancement and spontaneous regression of secondary sexual characteristics and menses in girls with McCune-Albright syndrome. The cause of the cyst formation is unknown but may be related to periodic elevation of as yet undefined serum factors such as follicle-stimulating hormone bioactive substances.

Mechanism of precocious puberty in McCune-Albright syndrome (MAS)

The hypotheses to explain precocious puberty in the MAS include premature pubertal gonadotropin secretion, and autonomous ovarian estradiol (E2) secretion without gonadotropin (LH and FSH) activation. We have used the observation that luteinizing hormone releasing hormone (LHRH) analogs suppress LH and FSH to prepubertal levels (Clin Res 29:504A,1981) to test the hypothesis of autonomous ovarian E2 secretion in MAS. A 5 y/o female presented with classic MAS (café-au-lait spots, polyostotic fibrous dysplasia, and precocious puberty). She was treated with D-Trp6-Pro9-NEt-LHRH (LHRHa), 4 μg/kg/s.c. daily, a regimen which decreases LH, FSH and E2 to prepubertal levels in all females with idiopathic precocious puberty (IPP). Results (mean±SE) are shown below.LHRH-stimulated gonadotropins remained <3mIU/ml throughout therapy. In contrast to IPP, this patient with MAS had marked cyclic E2 elevations during LHRHa therapy with no change of gonadotropins. E2 appeared to correlate with ovarian cyst size by ultrasound. We conclude that in MAS changes in ovarian estradiol secretion appear to be independent of changes in plasma gonadotropin concentration.