Gonadotroph adenomas as a cause of ovarian failure

Cover Page


Cite item

Full Text

Abstract

Aims of study. The current analysis was undertaken to evaluate the clinical significance of gonadotropin-secreting pituitary adenoma in the development of ovarian insufficiency.

Study design, materials and methods. This follow-up study included six observations of patients with prolonged amenorrhea caused by gonadotropin-secreting pituitary microadenoma.

Results. In addition to amenorrhea, patients had complaints of headaches in history or at present, signs of psychotic depression, and neuroticism up to mental disorders in one case. There was found a dynamic decrease in the secretion of follicle stimulating and luteinizing hormones on the background of normal prolactin secretion, lowered antimullerian hormone levels, and signs of diminished ovarian reserve according to ultrasound. A tendency to a simultaneous decrease in thyroid stimulating hormone and free thyroxin concentrations was also noted. Performing MRI with contrast enhancement revealed pituitary microadenoma in all patients. They had no clinical signs of acromegaly or Cushing’s disease, with the secretion of adrenocorticotropic hormone, cortisol, somatotropic hormone and insulin-like growth factor-1 remaining normal, which excluded corticotroph or somatotroph adenomas.

Conclusion. The clinical manifestation of gonadotroph adenomas, dependent on the secretory efficacy of gonadotropins and/or their subunits, is diverse. It includes the development of recurrent ovarian cysts, abdominal pain, metrorrhagia, and the development of persistent amenorrhea with psychosomatic disorders. If these symptoms are present, it is advisable to include pituitary MRI with contrast enhancement in the examination algorithm. Patients with gonadotroph adenomas are prescribed hormone replacement therapy and follow-up observation with dynamic MRI control of the tumor size (at 2–3-year intervals if no adenoma growth is seen).

About the authors

Margarita A. Repina

AVA-PETER Ltd.

Author for correspondence.
Email: marepina@inbox.ru

MD, PhD, DSci (Medicine), Professor, Honoured Scholar of the Russian Federation, Scientific Consultant

Russian Federation, Saint Petersburg

References

  1. Reindollar RH, Novak M, Tho SPT, McDonough PG. Adult-onset amenorrhea: A study of 262 patients. Am J Obstet Gynecol. 1986;155(3):531-541. https://doi.org/10.1016/0002-9378(86)90274-7.
  2. Gordon CM. Clinical practice. Functional hypothalamic amenorrhea. N Engl J Med. 2010;363(4):365-371. https://doi.org/10.1056/NEJMcp0912024.
  3. Loucks AB, Thuma JR. Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. J Clin Endocrinol Metab. 2003;88(1):297-311. https://doi.org/10.1210/jc.2002-020369.
  4. Uptodate.com [Internet]. Welt CK, Barbieri RL. Evaluation and management of secondary amenorrhea. UpToDate Literature review [cited 29 Mar 2019]. Available from: https://www.uptodate.com/contents/evaluation-and-management-of-secondary-amenorrhea.
  5. Daly AF, Rixhon M, Adam C, et al. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab. 2006;91(12):4769-4775. https://doi.org/10.1210/jc.2006-1668.
  6. Daly AF, Burlacu MC, Livadariu E, Beckers A. The epidemiology and management of pituitary incidentalomas. Horm Res. 2007;68 Suppl 5:195-198. https://doi.org/10.1159/000110624.
  7. Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf). 2010;72(3):377-382. https://doi.org/10.1111/j.1365-2265. 2009.03667.x.
  8. Cho HJ, Kim H, Kwak YJ, et al. Clinicopathologic analysis of pituitary adenoma: a single institute experience. J Korean Med Sci. 2014;29(3):405-410. https://doi.org/10.3346/jkms.2014.29.3.405.
  9. Jaffe CA. Clinically non-functioning pituitary adenoma. Pituitary. 2006;9(4):317-321. https://doi.org/10.1007/s11102-006-0412-9.
  10. Shimon I. Ovarian hyperstimulation without elevated serum estradiol associated with pure follicle-stimulating hormone-secreting pituitary adenoma. J Clin Endocrinol Metab. 2001;86(8):3635-3640. https://doi.org/10.1210/jcem.86.8.7766.
  11. Djerassi A. Gonadotroph adenoma in a premenopausal woman secreting follicle- stimulating hormone and causing ovarian hyperstimulation. J Clin Endocrinol Metab. 1995;80(2):591-594. https://doi.org/10.1210/jc.80.2.591.
  12. Ntali G, Capatina C, Grossman A, Karavitaki N. Functioning gonadotroph adenomas. The J Clin Endocrinol Metab. 2014;99(12):4423-4433. https://doi.org/10.1210/jc.2014-2362.
  13. Tashiro H, Katabuchi H, Ohtake H, et al. A follicle-stimulating hormone-secreting gonadotroph adenoma with ovarian enlargement in a 10-year-old girl. Fertil Steril. 1999;72(1):158-160. https://doi.org/10.1016/s0015-0282(99)00197-1.
  14. Gryngarten MG, Braslavsky D, Ballerini MG, et al. Spontaneous ovarian hyperstimulation syndrome caused by a follicle-stimulating hormone-secreting pituitary macroadenoma in an early pubertal girl. Horm Res Paediatr. 2010;73(4):293-298. https://doi.org/10.1159/000284395.
  15. Papanikolaou A, Michala L. autonomous ovarian cysts in prepubertal girls. How aggressive should we be? A Review of the Literature. J Pediatr Adolesc Gynecol. 2015;28(5):292-296. https://doi.org/10.1016/j.jpag.2015.05.004.
  16. Castelbaum AJ, Bigdeli H, Post KD, et al. Exacerbation of ovarian hyperstimulation by leuprolide reveals a gonadotroph adenoma. Fertil Steril. 2002;78(6):1311-1313. https://doi.org/10.1016/s0015-0282(02)04342-x.
  17. Chamoun R, Layfield L, Couldwell WT. Gonadotroph adenoma with secondary hypersecretion of testosterone. World Neurosurg. 2013;80(6):900.e907-911. https://doi.org/10.1016/j.wneu.2012.11.069.
  18. Saeger W, Geisler F, Lüdecke DK. Pituitary pathology in Cushing’s disease. Pathology – Research and Practice. 1988;183(5):592-595. https://doi.org/10.1016/s0344-0338(88)80018-9.
  19. Anasti JN. A potential novel mechanism for precocious puberty in juvenile hypothyroidism. J Clin Endocrinol Metab. 1995;80(1):276-279. https://doi.org/10.1210/jc.80.1.276.
  20. Buurman H, Saeger W. Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data. Eur J Endocrinol. 2006;154(5):753-758. https://doi.org/10.1530/eje.1.02107.
  21. Furgal-Borzych A, Lis GJ, Litwin JA, et al. Increased incidence of pituitary microadenomas in suicide victims. Neuropsychobiology. 2007;55(3-4):163-166. https://doi.org/10.1159/000106475.
  22. Falsetti L, Gambera A, Barbetti L, Specchia C. Long-term follow-up of functional hypothalamic amenorrhea and prognostic factors. J Clin Endocrinol Metab. 2002;87(2):500-505. https://doi.org/10.1210/jcem.87.2.8195.
  23. Katznelson L, Alexander JM, Klibanski A. Clinical review 45: Clinically nonfunctioning pituitary adenomas. J Clin Endocrinol Metab. 1993;76(5):1089-1094. https://doi.org/10.1210/jcem.76.5.8496297.
  24. Snyder PJ. Gonadotroph adenomas. In: Pituitary. 2nd ed. Ed. by S. Melmed. Malden: Blackwell Science Inc; 2002. 575 p.
  25. Colao A, Di Somma C, Pivonello R, et al. Medical therapy for clinically non-functioning pituitary adenomas. Endocr Relat Cancer. 2008;15(4):905-915. https://doi.org/10.1677/ERC-08-0181.

Copyright (c) 2019 Repina M.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies