ECE2022 Poster Presentations Reproductive and Developmental Endocrinology (61 abstracts)
Clinical/biochemical characteristics of functioning gonadotroph adenomas in women presenting with ovarian hyperstimulation
Nikoleta Papanikolaou 1 , Amy Coulden 2 , Nina Parker 1 , Sit Lee 3 , Chris Kelly 4 , Richard Anderson 5 , Aled Rees 6 , Jeremy Cox 1 , Waljit Dhillo 1 , Karim Meeran 1 , Maya Al-Memar 1 , Niki Karavitaki 2 & Channa Jayasena 1
1Imperial College Healthcare NHS Trust, London, United Kingdom; 2University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; 3The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; 4NHS Forth Valley, United Kingdom; 5University of Edinburgh Medical School, United Kingdom; 6Cardiff University, Cardiff, United Kingdom
Background: Functioning gonadotroph adenomas (FGA) are rare benign pituitary tumours. Several case reports suggest that FGA may present with features of ovarian hyperstimulation in women. However, a lack of aggregated clinical experience of FGA precludes the meaningful guidance of management in affected women.
Methods: Case series of 7 women presenting at different UK sites with FGA induced ovarian hyperstimulation syndrome (OHSS).
Results: Mean age was 31.6 years (range: 16-48) at diagnosis. 3/7 women underwent ovarian surgery prior to diagnosis of FGA. Two of those presented acutely unwell with abdominal pain, distention and palpable mass requiring oophorectomy for torted ovary/ruptured cyst. OHSS was classified as mild or moderate in all other cases. Abdominal pain, irregular periods, headache, visual disturbances, were also reported at presentation by 100%, 71%, 57%, 43% of women, respectively. Visual field defects were present in 6/7 women. Median follicle stimulating hormone (FSH) levels were 26.1 U/l (range:8.3-33), but luteinizing hormone (LH) was <2.5 U/l in all cases. Estradiol (E2) far exceeded the reference range in 5/7 women (2990 to >18000 pmol/l); E2 was at the upper limit of reference range in the remaining 2/7 women (960-1450 pmol/l). Hyperprolactinemia and deficiencies of other pituitary hormones were noted in 6/7 and 4/7 women, respectively. One woman had elevated thyroid stimulating hormone (TSH) and free thyroid hormones; histopathology subsequently confirmed a plurihormonal adenoma expressing TSH and FSH. Two patients were given lanreotide prior to surgical management but neither FSH, E2 nor tumour size responded to treatment. Duration of treatment was 6 and 12 weeks. Transsphenoidal surgery was performed in 6/7 women; resection was incomplete but OHSS symptoms and biochemistry improved post-operatively in all cases. The case with longest follow-up period had five transsphenoidal surgeries and radiotherapy twice over a period of 24 years.
Conclusion: This is the largest series of FGA in women. Transsphenoidal surgery remains the only effective treatment improving clinical and biochemical features of OHSS with FGA. Long-term clinical follow-up is required owing risk of adenoma recurrence. The long-term prognosis remains unclear for fertility in women diagnosed with FGA.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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