Endocrine Abstracts

Case report: We report a young woman with ovarian hyper stimulation syndrome (OHSS), headache, visual field defect and pituitary macro adenoma. The patient was treated about four years ago as pituitary PRL-secreting adenoma with carbergoline. The evaluation of other hormones FSH, LH and Estradiol values wasn’t done. The patient presented to our hospital with abdominal pain and headaches and amenohrrea. The pregnancy test was negative and pelcic ultrasound demonstrated enlarged ovaries with multiple cysts. The case was treated with GnRH agonist by gynecologist, but and the ovaries remain hyper stimulated and the estradiol and FSH values very high. The biopsy of ovaries was negative for malignancy (follicular luteinisation cysts. The pituitary macro adenoma secreting FSH was suspected. The laboratory results: β-HCG negative; Prolactine 83 ng/ml (N 4.3-32.3 ng/ml), FSH 103.3 IU/l (N 6.3-22 IU/l), LH 1.9 (N 1.5-8 IU/l), Estradiol>3000 pg/ml (N 38-200). The other hormones normal. MRI of the pituitary gland: Pituitary macroadenoma 35×20×25 mm with suprasellar extension, elevation and compression of the optic chiasm. Immunohistochemical staining of the pituitary adenoma specimen was positive for α subunit, FSHβ subunit and LHβ subunit; staining was negative for growth hormone, prolactin, adreno-corticotropic hormone and for TSH. The patient was diagnosed with gonodotrope cell adenoma with secondary ovarian hyperstimulation. After surgery of pituitary gland the gonadotropin and estradiol levels returned to normal range. Menstrual cycles resume and the ovaries revert to normal size with cyst remission.

Conclusion: Surgical resection is the definitive and primary therapy for OHSS due to gonadotropin-secreting adenomas. In those with recurrent tumors, radiation therapy may be required. In a patient with abdominal pain, irregular menses and multicystic ovaries the clinicians should measure the estradiol and gonadotropin levels to exclude OHSS.

Keywords: gonadotrope adenoma, ovarian hyperstimulation syndrome