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Yang W, Zheng J, Yang H, Li Q, Wang X, Bai Y, Yang S, Liu J. Functional gonadotroph pituitary adenoma: A case report. Heliyon 2024; 10:e24795. [PMID: 38304798 PMCID: PMC10830534 DOI: 10.1016/j.heliyon.2024.e24795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
Most clinically non-functioning pituitary tumour arise from gonadotroph cells. However, clinically functional pituitary gonadotroph adenoma is rare. Here we report a female case who presented with menstrual disturbances, however further workup demonstrated a pituitary microadenoma with elevated FSH and oestradiol level. Transsphenoidal resection was performed and the surgical histopathology confirmed pituitary gonadotroph adenoma. Postoperatively, improvement in both symptoms and hormonal profile were observed. Interestingly, the initially enlarged and polycystic ovaries became within normal range around eight months after the surgery. We suggest functional gonadotroph adenoma should be considered in the presence of gynaecological disorder with persistently elevated oestradiol and FSH levels.
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Affiliation(s)
- Wenzhen Yang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Jing Zheng
- Department of Gynecology, Maternity and Child Care Hospital of Gansu Province, Lanzhou, China
| | - Hu Yang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Qiang Li
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiaoqiang Wang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Yinliang Bai
- Department of Pharmacy, Lanzhou University Second Hospital, Lanzhou, China
| | - Shuting Yang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jie Liu
- Department of Neurosurgery, Qingyang People's Hospital, Qingyang City, China
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Papanikolaou N, Millar O, Coulden A, Parker N, Sit L, Kelly C, Cox J, Dhillo WS, Meeran K, Al Memar M, Anderson R, Rees DA, Karavitaki N, Jayasena CN. Clinical characteristics of functioning gonadotroph adenoma in women presenting with ovarian hyperstimulation: Audit of UK pituitary centres. Clin Endocrinol (Oxf) 2023; 99:386-395. [PMID: 37430451 DOI: 10.1111/cen.14949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/17/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Functioning gonadotroph adenomas (FGAs) are rare pituitary tumours stimulating ovarian function with potential life-threatening consequences in women. However, a lack of aggregated clinical experience of FGAs impairs management in affected women. The aim of this study is to present the clinical course of FGA-induced ovarian hyperstimulation syndrome (OHSS) cases as identified by some of the largest UK pituitary endocrine tertiary centres with a view to increasing awareness and improving diagnosis and management of women with FGA. DESIGN A retrospective observational study; audit of eight UK regional pituitary centres for cases of FGAs. SETTING Specialist neuroendocrine centres in the United Kingdom. PATIENTS AND MEASUREMENTS Women diagnosed with FGA-induced OHSS. Description of their clinical course. RESULTS Seven cases of FGA were identified in women, all causing OHSS. Mean age was 33.4 years at diagnosis. Abdominal pain, irregular periods, headache, and visual disturbances were reported at presentation by 100%, 71%, 57% and 43% of women, respectively. Three of seven women underwent ovarian surgery before FGA diagnosis. Six women underwent transsphenoidal surgery (TSS) with incomplete tumour resection in five of those, but all showed improvement or resolution in symptoms and biochemistry postoperatively. CONCLUSION FGA is a rare cause of spontaneous OHSS. TSS improves clinical and biochemical features of ovarian hyperstimulation in FGAs. Improved awareness of FGA will prevent inappropriate emergency ovarian surgery.
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Affiliation(s)
| | - Ophelia Millar
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Amy Coulden
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Edgbaston, Birmingham, UK
| | - Nina Parker
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lee Sit
- The Royal Infirmary of Edinburgh Hospital, Edinburgh, UK
| | - Chris Kelly
- Department of Endocrinology, Forth Valley Royal Hospital, Larbert, UK
| | - Jeremy Cox
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Waljit S Dhillo
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Karim Meeran
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Maya Al Memar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Richard Anderson
- MRC Centre for Reproductive Health, Institute of Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Edgbaston, Birmingham, UK
| | - Channa N Jayasena
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
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Tsukaguchi R, Hasebe M, Honjo S, Hamasaki A. Ovarian Hyperstimulation Syndrome Caused by Functional Gonadotroph Pituitary Adenoma. JCEM CASE REPORTS 2023; 1:luad087. [PMID: 37908987 PMCID: PMC10580461 DOI: 10.1210/jcemcr/luad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Indexed: 11/02/2023]
Abstract
Functional gonadotroph adenomas (FGAs) are rare, manifesting symptoms like menstrual irregularities or ovarian hyperstimulation syndrome (OHSS). We present a case of OHSS caused by an FGA during the follow-up of a pituitary tumor initially considered nonfunctioning. The patient presented with lower abdominal pain, abdominal swelling, and dyspnea. Magnetic resonance imaging (MRI) revealed 15 cm enlarged ovarian cysts and pleural effusion. Laboratory examination showed an elevated serum estradiol (E2) level (5741.4 pmol/L [1564.0 pg/mL]), suppressed luteinizing hormone, and nonsuppressed follicular-stimulating hormone (FSH). However, no pituitary hormone disorders were observed when a 19 mm pituitary tumor was discovered 11 months prior. Given the absence of human chorionic gonadotropin (hCG) administration, OHSS due to the FGA was suspected. Cabergoline, known for alleviating the severity of OHSS, was administered, but the ovarian cysts continued to enlarge. Subsequently, endoscopic transsphenoidal surgery was performed, and immunohistochemical analysis confirmed the diagnosis of the FSH-producing adenoma. Follow-up MRI scans showed reduced ovarian cysts and successful pituitary tumor resection with a reduced E2 level. This case highlights the importance of considering FGAs when encountering OHSS without hCG administration or following up on pituitary tumors in premenopausal female patients to take appropriate measures for accurate diagnosis and management.
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Affiliation(s)
- Ryo Tsukaguchi
- Department of Diabetes and Endocrinology, Medical Research Institute Kitano Hospital, Osaka, 530-8480, Japan
| | - Masashi Hasebe
- Department of Diabetes and Endocrinology, Medical Research Institute Kitano Hospital, Osaka, 530-8480, Japan
| | - Sachiko Honjo
- Department of Diabetes and Endocrinology, Medical Research Institute Kitano Hospital, Osaka, 530-8480, Japan
| | - Akihiro Hamasaki
- Department of Diabetes and Endocrinology, Medical Research Institute Kitano Hospital, Osaka, 530-8480, Japan
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Ntali G, Capatina C. Updating the Landscape for Functioning Gonadotroph Tumors. Medicina (B Aires) 2022; 58:medicina58081071. [PMID: 36013538 PMCID: PMC9414558 DOI: 10.3390/medicina58081071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Functioning gonadotroph adenomas (FGAs) are rare tumors, as the overwhelming majority of gonadotroph tumors are clinically silent. Literature is based on case reports and small case series. Gonadotroph tumors are poorly differentiated and produce and secrete hormones inefficiently, but in exceptional cases, they cause clinical syndromes due to hypersecretion of intact gonadotropins. The clinical spectrum of endocrine dysfunction includes an exaggerated response of ovaries characterized as ovarian hyperstimulation syndrome (OHSS) in premenopausal females and adolescent girls, testicular enlargement in males, and isosexual precocious puberty in children. Transsphenoidal surgery and removal of tumor reduces hormonal hypersecretion, improves endocrine dysfunction, and provides tissue for further analysis. Medical therapies (somatostatin analogues, dopamine agonists, GnRH agonists/antagonists) are partially or totally ineffective in many cases, especially with respect to antitumor effect. This review aims to update recent literature on these rare functioning tumors and highlight their therapeutic management.
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Affiliation(s)
- Georgia Ntali
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, 10676 Athens, Greece
- Correspondence:
| | - Cristina Capatina
- Department of Endocrinology, Carol Davila UMPh, 011863 Bucharest, Romania
- Department of Pituitary and Neuroendocrine diseases, CI Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
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An extremely rare case of pituitary functioning gonadotroph microadenoma accompanied by ovarian hyperstimulation syndrome in a reproductive-aged woman. F S Rep 2022; 3:79-83. [PMID: 35386509 PMCID: PMC8978087 DOI: 10.1016/j.xfre.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Design Setting Patients Interventions Main Outcome Measures Results Conclusions
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