Introduction: Among pituitary adenomas comprise approximately 10% of benign pituitary adenomas. These adenomas often arise in middle-aged men presenting with tumoral syndrome and endocrine profile of primary hypogonadism. Gonadotroph adenomas are more difficult to diagnose in women generally in perimenopausal or postmenopausal periods.
Case report: A 33-year-old woman with a 10 years of history of sterility with dysmenorrhea and pelvic pain in relation to recurrent ovarian cysts for 1 year. Because of gradually increasing pelvic pain associated with headache, the patient presented to our outpatient clinic for evaluation. Ultrasound examination revealed bilaterally enlarged ovaries containing multiple 23 cm cysts. She had no neurologic or visual complaints. An endocrine evaluation showed an FSH of 9.5 mIU/ml, LH of 0.3 mIU/ml, PRL of 680 mU/l, testosterone of 0.5 ng/ml, E2 of 1100 pg/ml, and α-subunit of1.2 ng/ml. Cerebral magnetic resonance imaging examination revealed a homogeneously enhancing mass of 21×22×18 mm within the pituitary, extending to the optic chiasm and to sphenoid and a second cystic tumor inside the prepontine cistern. The patient underwent a transphenoidal resection of both tumors. Histologic examination was consistent with a benign pituitary gonadotroph adenoma with cytoplasm immunoreacting focally with antibodies against FSH. The second tumor was a chordoma. Adjuvant radiotherapy was indicated for the residual tissue. The evolution was marked by disappearance of pelvic pain. The postoperative ultrasound examination showed normal ovaries without cysts. However, the patient remains in amenorrhea because of postoperative gonadotroph deficiency.
Conclusion: This case highlights the importance of endocrine assessment in the case of recurrent ovarian cysts. Moreover, this case arises the question of a potential link between gonadotroph tumors genesis and a contiguous tumor. Finally, we note the difficulty of management of such tumors especially after surgical treatment and radiotherapy in regard to fertility.
27 Apr - 01 May 2013
European Society of Endocrinology