Endocrine Abstracts

JOINT2669

Introduction: Granulosa cell tumors (GCTs) are rare ovarian malignancies. In adolescents it is often missed or diagnosis is delayed due to their nonspecific presentation. This case report highlights the significance of a high index of suspicion and the role of tumor markers in identifying rare causes of secondary amenorrhea.

Case History: A 16-year-old female, previously healthy, presented with a two-year history of secondary amenorrhea. She had no abdominal pain or other associated symptoms her physical examination was unremarkable. Initial laboratory investigations revealed low follicle-stimulating hormone (FSH) levels with elevated inhibin B, raising suspicion of an ovarian tumor. Initial ultra sound pelvis was normal, however follow up ultrasound imaging confirmed the presence of a left-sided ovarian mass. The patient underwent a left-sided salpingo-oophorectomy. Histopathological examination confirmed the diagnosis of an adult-type granulosa cell tumor with a Ki-67 proliferation index of 67%, and tumor staging revealed pT1aN0Mx. Postoperative tumor markers, including inhibin A and inhibin B, normalized, along with normalization of luteinizing hormone (LH) and FSH levels. She resumed regular menstruation following surgery. The patient was subsequently treated with adjuvant chemotherapy to address the high recurrence risk associated with adult-type granulosa cell tumors.

Conclusion: This case highlights the importance of considering granulosa cell tumor in the differential diagnosis of adolescent girls presenting with secondary amenorrhea, especially when initial findings deviate from common conditions such as polycystic ovary syndrome (PCOS). Early identification of granulosa cell tumors is critical, as adult-type tumors are associated with a significant risk of recurrence and require comprehensive treatment, including surgery and chemotherapy. Clinicians should maintain a high index of suspicion and utilize tumor markers, including inhibin A and B, to identify rare underlying etiologies of amenorrhea. This case highlights the need for timely diagnosis and management of granulosa cell tumors to improve outcomes and the importance of long-term follow-up in these patients.