育龄妇女垂体促性腺激素腺瘤的诊断

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.

多囊卵巢综合征胰岛素抵抗亚型:临床指标与发病机制

Objective This study was undertaken to compare clinical and biochemic al charac teristics of the insulin resistant (IR) and non-IR subphenotypes of polycystic ovary syndrome (PCOS). Study design Infertile PCOS women were classified as IR ( n=32) or non-IR(n=46) on the basis of fasting glucose and insulin levels. The i ncidence of acanthosis nigricans (AN), hirsutism, and ovulation in response to c lomiphene citrate (CC) was compared between the 2 groups, along with serum level s of gonadotropins, and sex steroids. Blood samples from 28 PCOS patients and 8 controls were analyzed by enzymatic immunoassay for autophosphorylated insulin r eceptor (APIR) and total insulin receptor (TIR) content. Results Insulin resista nce was associated with obesity (odds ratio <OR]=3.5, P < .05), AN (OR=6.0, P < .05), hirsutism (OR=3.1, P < .05), and resistance to CC (OR=5.0, P < .05). Mean levels of LH, LH/FSH ratios, and testosterone were lower in women with IR (11.5 ±6.8mIU/mL, 2.0 ±1.0, and 56.6 ±29.0 ng/dL, respectively) compared with women without IR (15.0 ±13.4 mIU/mL, 2.4 ±1.5, and 72.5 ±29.8 ng/dL, respectively) (P < .05). Mean APIR/TIR ratios in IR women were lower than in non-IR women (P < .05 at 100 nmol/L of insulin) and controls (P < .01 at 1, 10 and 100 nmol/L i nsulin). Conclusion Patients with IR are more likely to be obese and have AN, hi rsutism, resistance to CC, and lower LH, LH/FSH ratios, and testosterone levels. Furthermore, IR patients appear to have defective autophosphorylation of the in sulin receptor, a key element in insulin action, and a possible mechanism for IR in PCOS.

垂体影像学检查对高泌乳素血症的诊断价值

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.