Endocrine Abstracts

Background: Functioning gonadotroph adenomas (GA) account for 20 to 25% of all pituitary adenomas. Clinical presentation consists in multiple ovarian follicles and cysts, higher estradiol level and endometrial hyperplasia. The treatment of choice is transphenoidal tumor resection.

Case Presentation: A 40 year old woman presented with abdominal pain and menstrual cycle dysfunctions. Hormonal evaluation showed: FSH:13.8 mU/ml, estradiol:1549 pg/ml, PRL:81.7 ng/ml, 17OH-progesterone:5 ng/ml, testosterone levels: 0.30 ng/ml. In the hypothesis of GA, second level testing were performed. FSH, LH and PRL did not show any response to GnRH and TRH stimulation. Pelvic imaging showed: multiple miomas, increased uterine and ovarian volume with multiple cysts. Pelvic MRI was suggestive for ovarian hyperstimulation syndrome (OHSS) (right ovarian: 10.8 cm×5.6 cm; left ovarian: 3.7 cm×11.5 cm). Breast imaging showed high density of tissue, in absence of suspicious nodule. Brain MRI revealed a 17×20×17 mm pituitary lesion described as a macroadenoma. A 18-FDG-PET-TC showed an increased uptake of the lesion. Markers for gynecological tumors were negative. The patient underwent neurosurgery and histological documented a pituitary macroadenoma. Immunoistochemical was positive for LH, FSH, p53, CK-CAM5.2, chromogranin and negative for ACTH-GH-PRL-TSH. Ki67 was 2-3%. After surgery, the patients recovered. Periods were regular, breast tenderness disappeared and after 6 months, ovarian imaging was normal.

Conclusions: The finding of multiple ovarian cysts usually is present in polycystic ovary syndrome. A complete hormonal asset is always necessary, as a differential diagnosis can be GA. Generally, women with gonadotroph adenoma have severe hyperestrogenism, with inappropriate FSH values. GA can also have the same constellation of symptoms associated with OHHS. For that a correct hormonal, imaging and histological evaluation is necessary to confirm the diagnosis of GA.