Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurg. 2021 Jun;150:e162-e175. doi: 10.1016/j.wneu.2021.02.115. Epub 2021 Mar 5.
Gonadotroph pituitary adenoma (Gn-PA) may rarely cause ovarian hyperstimulation syndrome, leading to infertility in women, although this remains poorly described.
We present a quantitative systematic review including 2 patients from our institutional and 48 from the literature with Gn-PA causing ovarian hyperstimulation syndrome to thoroughly describe the clinical features and therapeutic outcomes from multidisciplinary aspects.
The patients had a mean age of 31.5 years and a mean follicle-stimulating hormone level of 14.4 IU/L. Estradiol level was high in 82% of patients, at >350 pg/mL. The mean maximal adenoma diameter was 22 mm, with a Knosp grade ≥3 in 10 patients. Abdominal surgery preceded adenoma resection in 24 patients (48%). Among 25 patients for whom extent of resection was recorded, total adenoma resection was achieved in 12. Through a mean follow-up of 25 months, adenoma recurrence was observed in 5 patients, who were treated with re-resection (n = 2), radiation (n = 2), and medical therapy followed by bilateral oophorectomy (n = 1). Medical therapies were partially effective or ineffective, and adenoma shrinkage did not follow; gonadotropin-releasing hormone agonists/antagonists were partially effective in 20% of patients (2/10), dopamine agonists in 44% (8/18), and somatostatin analogues in 50% (1/2). Four experienced swelling of tumor/ovaries after gonadotropin-releasing hormone agonists/antagonists administration. Overall, chemical remission was obtained in 26 of 28 patients, normalization of ovaries in 25 of 27, and successful pregnancy in 12 of 14.
Adenoma resection is the main treatment, leading to reduction in ovarian size and biochemical remission, with a high likelihood of subsequent spontaneous pregnancy. Increased awareness of this rare condition may help avoid unnecessary abdominal procedures.
促性腺激素垂体腺瘤（Gn-PA）可能很少导致卵巢过度刺激综合征，从而导致女性不孕，尽管这种情况描述得还不够详细。
我们进行了一项定量系统综述，纳入了来自我们机构的 2 例患者和文献中的 48 例因 Gn-PA 导致卵巢过度刺激综合征的患者，从多学科角度彻底描述了临床特征和治疗结果。
患者的平均年龄为 31.5 岁，卵泡刺激素水平平均为 14.4IU/L。82%的患者雌二醇水平升高，>350pg/ml。平均最大腺瘤直径为 22mm，10 例患者 Knosp 分级≥3。24 例患者（48%）在腺瘤切除前接受了腹部手术。在记录了切除范围的 25 例患者中，12 例患者实现了全腺瘤切除。通过平均 25 个月的随访，发现 5 例患者出现腺瘤复发，其中 2 例患者接受了再次切除，2 例患者接受了放射治疗，1 例患者接受了药物治疗后双侧卵巢切除术。药物治疗部分有效或无效，且腺瘤无缩小；促性腺激素释放激素激动剂/拮抗剂在 20%的患者（2/10）中部分有效，多巴胺激动剂在 44%的患者（8/18）中有效，生长抑素类似物在 50%的患者（2/2）中有效。4 例患者在使用促性腺激素释放激素激动剂/拮抗剂后出现肿瘤/卵巢肿胀。总体而言，28 例患者中有 26 例获得了化学缓解，27 例患者的卵巢功能正常，14 例患者中有 12 例成功妊娠。
腺瘤切除术是主要的治疗方法，可导致卵巢体积缩小和生化缓解，随后自然妊娠的可能性很高。提高对这种罕见疾病的认识可能有助于避免不必要的腹部手术。
