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Case Reports
. 2012:4:427-31.
doi: 10.2147/IJWH.S33386. Epub 2012 Aug 24.

Continuous follicle-stimulating hormone exposure from pituitary adenoma causes periodic follicle recruitment and atresia, which mimics ovarian hyperstimulation syndrome

Mika Kanaya  1 , Tsuyoshi Baba, Yoshimitsu Kitajima, Keiko Ikeda, Ayumi Shimizu, Miyuki Morishita, Hiroyuki Honnma, Toshiaki Endo, Tsuyoshi Saito
Affiliations
Case Reports

Continuous follicle-stimulating hormone exposure from pituitary adenoma causes periodic follicle recruitment and atresia, which mimics ovarian hyperstimulation syndrome

Mika Kanaya et al. Int J Womens Health. 2012.

Abstract

Context: Follicle-stimulating hormone (FSH)-secreting pituitary adenoma is usually a nonfunctioning tumor, but in rare cases it may develop into ovarian hyperstimulation. Several reports have revealed that serum FSH levels are normal to slightly high in patients with combined FSH-secreting pituitary adenoma with ovarian hyperstimulation. This finding is different from iatrogenic ovarian hyperstimulation syndrome (OHSS), which is associated with extremely high levels of FSH.

Objective: To describe the clinical course of two patients who developed OHSS from FSH-secreting pituitary adenoma.

Results: Endocrine studies of the two cases revealed that FSH levels were normal or slightly increased, but luteinizing hormone levels were low to undetectable. Their estradiol (E2) levels were intriguing: levels fluctuated drastically over 6 weeks in Case 1, but stayed flat in Case 2. Ultrasonographic examinations showed bilaterally enlarged multicystic ovaries, and magnetic resonance imaging indicated pituitary tumors. Transsephenoidal resection of the tumors ameliorated the symptoms and pathological diagnosis revealed FSH-secreting pituitary adenomas.

Conclusion: As is not the case in iatrogenic OHSS, even a small to moderate amount of FSH stimulation, which is continuously secreted by a pituitary adenoma, can cause ovarian hyperstimulation. Although FSH-secreting pituitary adenoma can cause ovarian hyperstimulation, an extremely high amount of E2 biosynthesis from granulosa cells seldom occurs.

Keywords: FSH; OHSS; estradiol; luteinizing hormone; pituitary adenoma.

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Figures

Figure 1
Figure 1
Fluctuation of estradiol (E2) levels after dilatation and curettage. Note: The periodic increase and decrease of the E2 levels are seen in follicle-stimulating hormone-secreting adenoma in an approximate 6-week cycle. Abbreviation: D and C, dilatation and curettage.
Figure 2
Figure 2
Fluctuation of estradiol (E2) levels after dilatation and curettage. The periodic increase and decrease of the E2 levels are seen in follicle-stimulating hormone (FSH)- secreting adenoma in an approximate a 6-week cycle. Note: Buserelin acetate nasal spray was administered three times per day for 8 weeks (daily dose, 900 μg). Abbreviations: GnRHa, gonadotropin-releasing hormone agonist; LH, luteinizing hormone.
Figure 3
Figure 3
Magnetic resonance imaging (MRI) and immunohistochemical findings of the two cases. (A and D) T1-weighted MRI images of Cases 1 and 2, respectively. Pituitary tumor was seen in each case. (B and E) Immunohistochemistry for follicle-stimulating hormone (FSH) in pituitary tumors derived from Cases 1 and 2, respectively. Positive staining for FSH was done for each specimen. (C and F) Immunohistochemistry for LH in pituitary tumors derived from Cases 1 and 2, respectively. Note: Negative staining for luteinizing hormone was seen in each specimen.
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References

    1. Beshay VE, Beshay JE, Halvorson LM. Pituitary tumors: diagnosis, management, and implications for reproduction. Semin Reprod Med. 2007;25(5):388–401. - PubMed
    1. Djerassi A, Coutifaris G, West VA, et al. Gonadotroph adenoma in a premenopausal woman secreting follicle-stimulating hormone and causing ovarian hyperstimulation. J Clin Endocrinol Metab. 1995;80(2):591–594. - PubMed
    1. Christin-Maitre S, Rongières-Bertrand G, Kottler ML, et al. A spontaneous and severe hyperstimulation of the ovaries revealing a gonadotroph adenoma. J Clin Endocrinol Metab. 1998;83(10):3450–3453. - PubMed
    1. Kajitani T, Liu S, Maruyama T, et al. Analysis of serum FSH bioactivity in a patient with an FSH-secreting pituitary microadenoma and multicystic ovaries: A case report. Hum Reprod. 2008;23(2):435–439. - PubMed
    1. Baba T, Endo T, Kitajima Y, Kamiya H, Moriwaka O, Saito T. Spontaneous ovarian hyperstimulation syndrome and pituitary adenoma: incidental pregnancy triggers a catastrophic event. Fertil Steril. 2009;92(1):390. e1–e3. - PubMed

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