Objective: To describe the clinical symptoms associated with the diagnosis of pituitary gonadotroph adenoma in premenopausal women. Design: Report of three separate cases. Setting: University medical center. Patient(s...Objective: To describe the clinical symptoms associated with the diagnosis of pituitary gonadotroph adenoma in premenopausal women. Design: Report of three separate cases. Setting: University medical center. Patient(s): Three patients: a 31-year-old woman with primary infertility, recurrent adnexal masses, and highly elevated estradiol level; a 30-year-old woman with recurrent multicystic ovaries following multiple cystectomies and transvaginal cyst aspirations, and elevated estradiol level; a 43-year-old woman with bilateral complex cystic adnexal masses and an elevated estradiol level, who under-went a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a suspected granulosa cell tumor. Intervention(s): Transsphenoidal resection of a pituitary mass. Main Outcome Measure(s): Serum estradiol, FSH, and LH levels; transvaginal ultrasonography of the ovaries; histologic examination of pituitary tumors. Result(s): Transsphenoidal resection of pituitary adenomas resulted in normalization of serum estradiol and FSH levels and resolution of adnexal masses in two of the women. Conclusion(s): Pituitary gonadotroph adenoma must be considered in the differential diagnosis in reproductive-aged women presenting with the clinical symptom triad of new onset oligomenorrhea, bilateral cystic adnexal masses, and elevated estradiol and FSH levels with suppressed levels of LH; timely diagnosis may prevent unnecessary and potentially damaging surgical procedures.展开更多
Objective: To evaluate the signs and symptoms associated with hyperprolactinemia and establish guidelines for a minimal serum PRL level for which pituitary imaging is indicated. Design: Retrospective study. Setting: R...Objective: To evaluate the signs and symptoms associated with hyperprolactinemia and establish guidelines for a minimal serum PRL level for which pituitary imaging is indicated. Design: Retrospective study. Setting: Reproductive endocrinology clinic in a university hospital. Patient(s): One hundred four consecutive patients with hyperprolactinemia, mean age 30 ± 6.5 (range 19- 44) years. Intervention(s): Classification of clinical symptoms, serum hormone measurements, and pituitary magnetic resonance imaging (MRI). Main Outcome Measure(s): Incidence of presenting symptoms, serum PRL levels, and pituitary tumor size. Result(s): Median (range)- PRL value was 82.6 ng/mL (25- 1,342). Reported symptoms from most to least common were infertility (48% ), headaches (39% ), oligoamenorrhea (29% ), galactorrhea (24% ), and visual changes (13% ). Hypothyroidism was diagnosed in 2 of 104 (1.9% ) patients. Of 86 patients who had pituitary imaging, 23 (26% ) had normal findings and 63 (74% ) had pituitary tumor; of these, 47 (55% of total imaged) had microadenomas and 16 (19% of total imaged) had macroadenomas. There was a statistically significant association between the tumor sizeand the PRL level. However, 11% of the patients with microadenomas had PRL levels >200 ng/mL, and 44% of the patients with macroadenomas had PRL levels between 25 and 200 ng/mL. Conclusion(s): The most common symptoms in the population studied were infertility and headaches. Coexisting thyroid disease was an uncommon finding. Most patients had a pituitary tumor on MRI. Although tumor size correlated with the serum PRL level, some macroadenomas were detected in women with only moderately elevated PRL values. On the basis of these findings, pituitary imaging should be obtained to identify pituitary tumors in all patients with persistently elevated PRL levels.展开更多
文摘Objective: To describe the clinical symptoms associated with the diagnosis of pituitary gonadotroph adenoma in premenopausal women. Design: Report of three separate cases. Setting: University medical center. Patient(s): Three patients: a 31-year-old woman with primary infertility, recurrent adnexal masses, and highly elevated estradiol level; a 30-year-old woman with recurrent multicystic ovaries following multiple cystectomies and transvaginal cyst aspirations, and elevated estradiol level; a 43-year-old woman with bilateral complex cystic adnexal masses and an elevated estradiol level, who under-went a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a suspected granulosa cell tumor. Intervention(s): Transsphenoidal resection of a pituitary mass. Main Outcome Measure(s): Serum estradiol, FSH, and LH levels; transvaginal ultrasonography of the ovaries; histologic examination of pituitary tumors. Result(s): Transsphenoidal resection of pituitary adenomas resulted in normalization of serum estradiol and FSH levels and resolution of adnexal masses in two of the women. Conclusion(s): Pituitary gonadotroph adenoma must be considered in the differential diagnosis in reproductive-aged women presenting with the clinical symptom triad of new onset oligomenorrhea, bilateral cystic adnexal masses, and elevated estradiol and FSH levels with suppressed levels of LH; timely diagnosis may prevent unnecessary and potentially damaging surgical procedures.
文摘Objective: To evaluate the signs and symptoms associated with hyperprolactinemia and establish guidelines for a minimal serum PRL level for which pituitary imaging is indicated. Design: Retrospective study. Setting: Reproductive endocrinology clinic in a university hospital. Patient(s): One hundred four consecutive patients with hyperprolactinemia, mean age 30 ± 6.5 (range 19- 44) years. Intervention(s): Classification of clinical symptoms, serum hormone measurements, and pituitary magnetic resonance imaging (MRI). Main Outcome Measure(s): Incidence of presenting symptoms, serum PRL levels, and pituitary tumor size. Result(s): Median (range)- PRL value was 82.6 ng/mL (25- 1,342). Reported symptoms from most to least common were infertility (48% ), headaches (39% ), oligoamenorrhea (29% ), galactorrhea (24% ), and visual changes (13% ). Hypothyroidism was diagnosed in 2 of 104 (1.9% ) patients. Of 86 patients who had pituitary imaging, 23 (26% ) had normal findings and 63 (74% ) had pituitary tumor; of these, 47 (55% of total imaged) had microadenomas and 16 (19% of total imaged) had macroadenomas. There was a statistically significant association between the tumor sizeand the PRL level. However, 11% of the patients with microadenomas had PRL levels >200 ng/mL, and 44% of the patients with macroadenomas had PRL levels between 25 and 200 ng/mL. Conclusion(s): The most common symptoms in the population studied were infertility and headaches. Coexisting thyroid disease was an uncommon finding. Most patients had a pituitary tumor on MRI. Although tumor size correlated with the serum PRL level, some macroadenomas were detected in women with only moderately elevated PRL values. On the basis of these findings, pituitary imaging should be obtained to identify pituitary tumors in all patients with persistently elevated PRL levels.
