Endocrine Abstracts

Introduction: Our case is a young couple, both endocrinologically monitored from childhood. Woman with diagnosis of oligomenorrhea – secondary amenorrhea. Man with delayed puberty. After complex endocrinological screening both diagnoses was changed to: woman diagnosed with prolactinoma and man with isolated idiopathic central hypogonadism (IICH). They were trying to concieve for 10 years with no succes.

Case: Woman: At 17 years of age diagnosed cystic degenerative pituitary adenoma with compression of the optic chiasm, producing prolactin. Surgery was carried out. After surgery hyperprolactinomia persisted. Treatment with dopamine agonists was introduced. Treatment with bromocriptine was not tolerated with gastrointestine tract. Quinagolide and cabergoline produced insufficient decline of prolactine levels even at maximum dosing. Residuum of tumor showed little growth progress. Primary infertility, persisting secondary amenorrhea and growth of tumor residuum led to second surgery at 30 years of age. Before that she underwent several unsucessful IVF treatment rounds. After surgery MRI scan showed that pituitary tumor was resected completely. Levels of prolactine reached normal values and other pituitary hormones remained functional. Normal menstrual cycle was regained with succesful spontaneous gravidity within one month after surgery. After 3 years second spontaneous gravidity followed. Man: Diagnosed with IICH. At 16 years of age diagnosed with delayed puberty with genital hypoplasia. Anosmia was not present. MRI of hypothalamo pituitary area showed no deposit. Cythogenethic survey confirmend normal male karyotype. Also oligoteratozoospermia and spermiogram surveys were carried out. Treatment with chorione gonadotropine with slow enhancement of clinical picture. Treatment of central hypogonadism continued also in adult age.

Conclusion: Woman with pituitary adenoma caused hyperprolactinemia underwent repeated change of medical treatment and two surgeries with complete remission. Man diagnosed with IICH, at first treated with chorionic gonadotropin injection. After second succesful gravidity treatment was changed to DEPO testosterone injection. Two sucesfully treated endocriopathies led to spontaneous gravidity.