An unusual case of secondary amenorrhea
L O'Shea1, E Callally1, E Leen2, C Barry-Kinsella3 & S Screenan2
We present the case of a 31 year-old woman, para 2, who presented with a 2-year history of secondary amenorrhea. History and physical examination were otherwise unremarkable. Androgen and prolactin levels were normal. LH levels (10.3 U/L) and estrogen levels (280 pmol/l) were normal but FSH levels were repeatedly low ( < 1 U\/l). Growth hormone, free T4, TSH and cortisol levels were also normal. Pelvic ultrasound showed an enlarged right ovary (8 x 5 x 5 cms). Surgery, revealed a tumor, confined to the right ovary. The ovary was removed. Histopathology revealed a granulosa cell tumour (GCT) with no evidence of vascular invasion or necrosis. No adjuvant therapy was deemed necessary. The patient menstruated prior to discharge from hospital. In summary we present the case of a woman with secondary amenorrhea, associated with isolated FSH deficiency, due to a GCT. GCT is the commonest germ cell tumour of the ovary and has been reported to secrete various hormones and peptides including inhibin. Although levels were not available prior to surgery, immunohistochemistry for inhibin staining of the tumor is pending. We believe that the subject's FSH deficiency and amenorrhea were due to inhibin secretion by the GCT.