GONADOTROPH ADENOMA IN A PREMENOPAUSAL WOMAN SECRETING FOLLICLE-STIMULATING-HORMONE AND CAUSING OVARIAN HYPERSTIMULATION
GONADOTROPH ADENOMA IN A PREMENOPAUSAL WOMAN SECRETING FOLLICLE-STIMULATING-HORMONE AND CAUSING OVARIAN HYPERSTIMULATION
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DOI：
10.1210/jc.80.2.591
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发表时间：
1995-02-01
影响因子：
5.8
通讯作者：
SNYDER, PJ
中科院分区：
文献类型：
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作者：
DJERASSI, A;COUTIFARIS, C;SNYDER, PJ
促性腺激素腺瘤的临床表现几乎都是神经性的，这是其体积大的结果，很少是内分泌性的。我们报道了一名 39 岁女性的例外情况，她的促性腺激素腺瘤导致血清 FSH 浓度超正常，从而导致多发性卵巢囊肿、血清雌二醇浓度持续升高和子宫内膜增生。她最初因 30 岁时闭经而就诊，并于 31 岁时通过经蝶手术治疗鞍内肿块，并于 36 岁时再次接受治疗。第二次手术前后，她的血浆雌二醇浓度持续超正常（>1840 pmol/L），子宫内膜增生。当她 39 岁时接受评估时，经阴道超声检查显示多发性卵巢囊肿和子宫内膜增厚。血浆雌二醇水平显着超正常（2160 pmol/L），FSH轻度超正常（17.8 IU/L），α亚基显着超正常（23.3 μg/L）。具有促性腺激素腺瘤的特征，TRH 后，她的 LH β 水平增加了 69%。给予 GnRH 拮抗剂 Nal-Glu-GnRH（5 毫克/12 小时，持续 4 周）后，FSH 和 cr 亚基均未下降。切除的腺瘤组织表现出促性腺激素腺瘤的形态学特征。该患者似乎很独特，因为她的促性腺激素腺瘤引起轻微但持续的FSH浓度超正常，从而引起卵巢刺激，包括血浆雌二醇浓度超正常、多发性卵巢囊肿和子宫内膜增生。我们建议在具有这一系列异常的患者的鉴别诊断中考虑促性腺激素腺瘤。
The clinical manifestations of gonadotroph adenomas are almost always neurological, consequences of their large size, and are rarely endocrinological. We report an exception, a 39-yr-old woman whose gonadotroph adenoma caused supranormal serum concentrations of FSH, which resulted in the development of multiple ovarian cysts, persistent elevation of her serum estradiol concentration, and endometrial hyperplasia.She initially presented because of amenorrhea at age 30 yr and was treated for an intrasellar mass by transsphenoidal surgery at age 31 yr and again at age 36 yr. Before and after the second operation she had persistently supranormal plasma estradiol concentrations (>1840 pmol/L) and endometrial hyperplasia. When she was evaluated at age 39 yr, transvaginal ultrasound showed multiple ovarian cysts and endometrial thickening. Her plasma estradiol level was markedly supranormal (2160 pmol/L), FSH was mildly supranormal (17.8 IU/L), and alpha-subunit was markedly supranormal (23.3 mu g/L). Characteristic of gonadotroph adenomas, her LH beta level increased by 69% in response to TRH. Neither FSH nor cr-subunit decreased in response to administration of the GnRH antagonist, Nal-Glu-GnRH (5 mg/12 h for 4 weeks). Excised adenoma tissue exhibited morphological features of a gonadotroph adenoma.This patient appears to be unique, in that her gonadotroph adenoma caused slightly, but persistently, supranormal concentrations of FSH, which caused ovarian stimulation, including supranormal plasma estradiol concentrations, multiple ovarian cysts, and endometrial hyperplasia. We propose that gonadotroph adenomas be considered in the differential diagnosis of patients who have this constellation of abnormalities.