Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 1138655, Japan.
Department of Pituitary and Hypothalamic Surgery, Toranomon Hospital, Tokyo 1058470, Japan.
Endocr J. 2019 Jul 28;66(7):653-656. doi: 10.1507/endocrj.EJ19-0066. Epub 2019 Apr 19.
A 34-year-old woman presented our hospital with complaint of irregular menstruation and abnormal uterine bleeding lasting for a month. After her second parturition at the age of 27, her menstrual cycle had been regular, but it suddenly became irregular at the age of 30. Transvaginal ultrasound revealed the presence of ovarian mass, and the patient underwent diagnostic laparoscopic surgery. Bilateral ovaries temporally shrink after puncture but the size soon resumed. Gonadotropins were almost normal, but estradiol and PRL levels turned out to be elevated, and cabergoline treatment was initiated. After referral to our hospital, we found that the ovaries showed multifollicular appearance. Brain magnetic resonance imaging showed an 18-mm macroadenoma in the suprasellar area. To suppress the secretion of endogenous gonadotropins and estrogen, low-dose estrogen-progestin was prescribed. Surprisingly, the treatment temporarily reduced the size of the ovaries. The patient was referred to a neurosurgeon, and a functioning gonadotroph adenoma was suspected. After the resection of the pituitary tumor, her menstrual cycle became regular, and the size of bilateral ovaries became normal. We also noticed that her ovarian reserve judged by anti-Müllerian hormone had been almost diminished after the surgical treatment, probably reflecting the exhaustion of follicular pool. Women with multifollicular ovaries and elevated estradiol levels may have functioning gonadotroph adenomas, although the level of FSH is relatively normal, and ovarian reserve can be followed by measuring anti-Müllerian hormone.
一位 34 岁女性因月经不规则和异常子宫出血持续一个月来我院就诊。她在 27 岁时分娩后月经周期一直很规律，但在 30 岁时突然变得不规律。经阴道超声显示卵巢有肿块，患者接受了诊断性腹腔镜手术。卵巢穿刺后暂时缩小，但很快又恢复了原来的大小。促性腺激素几乎正常，但雌二醇和 PRL 水平升高，开始使用卡麦角林治疗。转至我院后，我们发现卵巢呈多滤泡状。脑磁共振成像显示鞍上区有一个 18 毫米的大腺瘤。为了抑制内源性促性腺激素和雌激素的分泌，给予小剂量雌激素-孕激素。令人惊讶的是，治疗暂时缩小了卵巢的大小。患者被转介给神经外科医生，怀疑是功能性促性腺激素腺瘤。垂体肿瘤切除后，她的月经周期恢复正常，双侧卵巢大小也恢复正常。我们还注意到，她的卵巢储备功能（通过抗苗勒管激素评估）在手术后几乎已经耗尽，这可能反映了卵泡池的衰竭。有多滤泡卵巢和雌二醇水平升高的女性可能患有功能性促性腺激素腺瘤，尽管 FSH 水平相对正常，可以通过测量抗苗勒管激素来监测卵巢储备功能。
