Exacerbation of ovarian hyperstimulation by leuprolide reveals a gonadotroph adenoma
Exacerbation of ovarian hyperstimulation by leuprolide reveals a gonadotroph adenoma
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DOI：
10.1016/s0015-0282(02)04342-x
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发表时间：
2002-12-01
影响因子：
6.7
通讯作者：
Snyder, PJ
中科院分区：
文献类型：
--
作者：
Castelbaum, AJ;Bigdeli, H;Snyder, PJ
目的：报告一例促性腺激素腺瘤，在雌二醇水平急剧升高和促性腺激素释放激素激动剂引起卵巢过度刺激后诊断。设计：病例报告。设置：门诊实践和大学医院。患者：一名35岁女性，表现为不孕、闭经和基础雌二醇浓度升高。干预措施：超声检查、腹腔镜检查、内分泌测定、磁共振成像、经蝶手术和免疫细胞化学染色。主要结果测量：超声和腹腔镜检查显示双侧卵巢增大，含有多个排卵前卵泡，与接受外源性FSH控制性超促排卵的妇女相似。血清雌二醇水平中度升高，FSH水平在正常范围内，LH受到抑制。醋酸亮丙瑞林给药导致雌二醇浓度非常升高，甚至导致卵巢囊肿更大。磁共振成像显示鞍区肿块。经蝶窦切除的组织检查显示垂体腺瘤，FSH染色强烈。结果：促性腺激素腺瘤切除后不久恢复正常月经，随后自然妊娠。结论：育龄期妇女月经过少或闭经，不孕，排卵前卵泡多，血清雌二醇浓度持续升高在这种情况下，促性腺激素释放激素激动剂引起的卵巢过度刺激加重也强烈提示促性腺激素腺瘤，但可以通过认识这种情况的表现特征来避免。
Objective: To report a case of a gonadotroph adenoma diagnosed after a dramatic increase in estradiol level and ovarian hyperstimulation in response to a gonadotropin-releasing hormone agonist.Design: Case report.Setting: Outpatient practice and university hospital.Patient(s): A 35-year-old woman who presented with infertility, amenorrhea, and an elevated basal estradiol concentration.Intervention(s): Ultrasonography, laparoscopy, endocrinologic assays, magnetic resonance imaging, trans-sphenoidal surgery, and immunocytochemical staining.Main Outcome Measure(s): Ultrasonography and laparoscopy demonstrated bilaterally enlarged ovaries containing multiple preovulatory follicles, similar in appearance in those women undergoing controlled ovarian hyperstimulation with exogenous FSH. The serum estradiol level was moderately elevated, the FSH level was within the normal range, and LH was suppressed. Administration of leuprolide acetate resulted in very elevated estradiol concentrations and even larger ovarian cysts. Magnetic resonance imaging demonstrated a sellar mass. Examination of the tissue excised by transsphenoidal excision of the mass showed a pituitary adenoma that stained strongly for FSH.Result(s): Regular menses resumed soon after excision of the gonadotroph adenoma, followed by a spontaneous pregnancy.Conclusion(s): Gonadotroph adenoma should be suspected in a reproductive age woman with oligomenorrhea or amenorrhea, infertility, multiple preovulatory follicles, and a persistently elevated serum estradiol concentration. Exacerbation of the ovarian hyperstimulation in response to a gonadotropin-releasing hormone agonist in this setting also strongly suggests a gonadotroph adenoma but can be avoided by recognizing the presenting features of this condition.