Diagnosis of pituitary gonadotroph adenomas in reproductive-aged women.

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 underwent 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.