Ovarian hyperstimulation caused by gonadotroph cell adenoma: A case report and review of the literature

Abstract

Objective. We present a case of spontaneous ovarian hyperstimulation caused by pituitary gonadotroph macroadenoma, and include a review of the literature.

Case report. A 27-year-old woman presented with irregular menstruation and bilateral multicystic enlargement of the ovaries. Serum estradiol (E₂) levels were marginally elevated for the follicular phase but within the physiological range. Serum luteinizing hormone (LH) was extremely low, follicle-stimulating hormone (FSH) was normal, and prolactin (PRL) was high. Magnetic resonance imaging disclosed a pituitary macroadenoma. Immunohistochemical examination of the surgically removed adenoma showed intense reactivity for FSH and LH. After the operation, E₂, LH and PRL levels were normalized, the ovaries returned to a normal morphology, and regular menstrual cycles were resumed.

Conclusion. A review of the literature showed that ovarian hyperstimulation caused by pituitary gonadotroph adenoma is not always accompanied by elevated FSH levels. High PRL and E₂ and low LH were reported in the majority of the cases, but E₂ may stay within the range observed in normal menstrual cycles.

Keywords:

• Gonadotroph adenoma
• pituitary adenoma
• follicle-stimulating hormone
• hyperstimulation
• ovary