Gonadotroph adenomas as a cause of ovarian failure

Abstract

Aims of study. The current analysis was undertaken to evaluate the clinical significance of gonadotropin-secreting pituitary adenoma in the development of ovarian insufficiency. Study design, materials and methods. This follow-up study included six observations of patients with prolonged amenorrhea caused by gonadotropin-secreting pituitary microadenoma. Results. In addition to amenorrhea, patients had complaints of headaches in history or at present, signs of psychotic depression, and neuroticism up to mental disorders in one case. There was found a dynamic decrease in the secretion of follicle stimulating and luteinizing hormones on the background of normal prolactin secretion, lowered antimullerian hormone levels, and signs of diminished ovarian reserve according to ultrasound. A tendency to a simultaneous decrease in thyroid stimulating hormone and free thyroxin concentrations was also noted. Performing MRI with contrast enhancement revealed pituitary microadenoma in all patients. They had no clinical signs of acromegaly or Cushing’s disease, with the secretion of adrenocorticotropic hormone, cortisol, somatotropic hormone and insulin-like growth factor-1 remaining normal, which excluded corticotroph or somatotroph adenomas. Conclusion. The clinical manifestation of gonadotroph adenomas, dependent on the secretory efficacy of gonadotropins and/or their subunits, is diverse. It includes the development of recurrent ovarian cysts, abdominal pain, metrorrhagia, and the development of persistent amenorrhea with psychosomatic disorders. If these symptoms are present, it is advisable to include pituitary MRI with contrast enhancement in the examination algorithm. Patients with gonadotroph adenomas are prescribed hormone replacement therapy and follow-up observation with dynamic MRI control of the tumor size (at 2–3-year intervals if no adenoma growth is seen).