Ishii Reo, Harai Nozomi, Hosokawa Tadatsugu, Tahara Ippei, Ogiwara Masakazu, Tsuchiya Kyoichiro
Department of Diabetes and Endocrinology, University of Yamanashi Hospital, Yamanashi 4093898, Japan.
Department of Pathology, University of Yamanashi Hospital, Yamanashi 4093898, Japan.
JCEM Case Rep. 2024 Dec 6;2(12):luae231. doi: 10.1210/jcemcr/luae231. eCollection 2024 Dec.
A 49-year-old woman presented with irregular menstrual bleeding, elevated estradiol (E2) (665 pg/mL [2441.21 pmol/L]) (reference range [RR]: menstrual period [MP] 20-50 pg/mL; 73.42-183.55 pmol/L), unsuppressed follicle-stimulating hormone (FSH) (19.3 mIU/mL [19.3 IU/L]) (RR: MP 3.5-10.0 mIU/mL; 3.5-10.0 IU/L), and cystic ovarian enlargement (right ovary, 109 mL; left ovary, 146 mL). A 7-mm pituitary microadenoma was also observed, and 6 months after referral, endoscopic transsphenoidal surgery was performed, resulting in a diagnosis of FSH-producing pituitary adenoma. Nine months postoperatively, the ovarian cysts had markedly shrunk. Although FSH-producing pituitary adenomas are rare, approximately 64% of nonfunctioning pituitary adenomas are positive for gonadotropin immunostaining. FSH-producing pituitary adenomas are often endocrinologically silent, with symptoms typically triggered by pituitary tumor enlargement. Early diagnosis can be facilitated by measuring FSH and E2 levels in cases of irregular vaginal bleeding, abnormal menstruation, ovarian enlargement, ovarian hyperstimulation syndrome, or infertility. If E2 is elevated but FSH is not suppressed, pituitary magnetic resonance imaging should be performed to identify FSH-producing pituitary adenomas. In cases of FSH-producing pituitary adenomas, including microadenomas, symptoms may improve after tumor resection, making surgery the preferred treatment option.
一名49岁女性出现月经不规则出血，雌二醇（E2）水平升高（665 pg/mL [2441.21 pmol/L]）（参考范围[RR]：月经期[MP] 20 - 50 pg/mL；73.42 - 183.55 pmol/L），促卵泡生成素（FSH）未被抑制（19.3 mIU/mL [19.3 IU/L]）（RR：MP 3.5 - 10.0 mIU/mL；3.5 - 10.0 IU/L），以及卵巢囊性增大（右卵巢，109 mL；左卵巢，146 mL）。还观察到一个7毫米的垂体微腺瘤，转诊6个月后进行了内镜经蝶窦手术，结果诊断为分泌FSH的垂体腺瘤。术后9个月，卵巢囊肿明显缩小。虽然分泌FSH的垂体腺瘤很少见，但约64%的无功能垂体腺瘤促性腺激素免疫染色呈阳性。分泌FSH的垂体腺瘤通常在内分泌方面无明显症状，症状通常由垂体肿瘤增大引发。对于出现不规则阴道出血、月经异常、卵巢增大、卵巢过度刺激综合征或不孕的病例，测量FSH和E2水平有助于早期诊断。如果E2升高但FSH未被抑制，应进行垂体磁共振成像以识别分泌FSH的垂体腺瘤。对于分泌FSH的垂体腺瘤，包括微腺瘤，肿瘤切除后症状可能改善，因此手术是首选的治疗方案。
