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Follicle Stimulating Hormone–Secreting Pituitary Microadenoma With Fluctuating Levels of Ovarian Hyperstimulation

Maruyama, Tetsuo MD, PhD; Masuda, Hirotaka MD; Uchida, Hiroshi MD, PhD; Nagashima, Takashi MD; Yoshimura, Yasunori MD, PhD

doi: 10.1097/01.AOG.0000141554.50747.16
Case Reports

BACKGROUND: Enlarged multicystic ovaries and an elevated estradiol (E2) concentration have been reported as characteristics of follicle stimulating hormone (FSH)-secreting adenomas in reproductive-aged women. The natural course of the hormone in relationship to the microadenoma and ovarian findings, however, remains largely unknown.

CASE: A 40-year-old woman with enlarged multicystic ovaries was nonsurgically diagnosed with an FSH-producing pituitary microadenoma. During her subsequent 12-month follow-up, the serum concentration of E2, but not FSH, and the size of the multicystic ovaries fluctuated dramatically. Both the E2 level and ovarian size were transiently normalized.

CONCLUSION: Because of disease-related fluctuations, a reproductive-aged woman with an FSH-producing adenoma did not always present with laboratory values characteristic of ovarian hyperstimulation. This finding points out a possible pitfall in diagnosis and clinical management.

A premenopausal woman with a follicle stimulating hormone–secreting pituitary microadenoma exhibited dramatic fluctuations in serum estradiol concentrations and ovarian hyperstimulation during conservative management.

Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan

Received May 26, 2004. Received in revised form June 16, 2004. Accepted July 1, 2004.

Address reprint requests to: Tetsuo Maruyama, MD, Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160–8582, Japan; e-mail:

© 2005 The American College of Obstetricians and Gynecologists