Clinical characteristics of functioning gonadotroph adenoma in women presenting with ovarian hyperstimulation: audit of UK pituitary centres
Author(s)
Type
Journal Article
Abstract
Objective
Functioning gonadotroph adenomas (FGAs) are rare pituitary tumours stimulating ovarian function with potential life-threatening consequences in women. However, a lack of aggregated clinical experience of FGAs impairs management in affected women. The aim of this study is to present the clinical course of FGA-induced ovarian hyperstimulation syndrome (OHSS) cases as identified by some of the largest UK pituitary endocrine tertiary centres with a view to increasing awareness and improving diagnosis and management of women with FGA.
Design
A retrospective observational study; audit of eight UK regional pituitary centres for cases of FGAs.
Setting
Specialist neuroendocrine centres in the United Kingdom.
Patients and Measurements
Women diagnosed with FGA-induced OHSS. Description of their clinical course.
Results
Seven cases of FGA were identified in women, all causing OHSS. Mean age was 33.4 years at diagnosis. Abdominal pain, irregular periods, headache, and visual disturbances were reported at presentation by 100%, 71%, 57% and 43% of women, respectively. Three of seven women underwent ovarian surgery before FGA diagnosis. Six women underwent transsphenoidal surgery (TSS) with incomplete tumour resection in five of those, but all showed improvement or resolution in symptoms and biochemistry postoperatively.
Conclusion
FGA is a rare cause of spontaneous OHSS. TSS improves clinical and biochemical features of ovarian hyperstimulation in FGAs. Improved awareness of FGA will prevent inappropriate emergency ovarian surgery.
Functioning gonadotroph adenomas (FGAs) are rare pituitary tumours stimulating ovarian function with potential life-threatening consequences in women. However, a lack of aggregated clinical experience of FGAs impairs management in affected women. The aim of this study is to present the clinical course of FGA-induced ovarian hyperstimulation syndrome (OHSS) cases as identified by some of the largest UK pituitary endocrine tertiary centres with a view to increasing awareness and improving diagnosis and management of women with FGA.
Design
A retrospective observational study; audit of eight UK regional pituitary centres for cases of FGAs.
Setting
Specialist neuroendocrine centres in the United Kingdom.
Patients and Measurements
Women diagnosed with FGA-induced OHSS. Description of their clinical course.
Results
Seven cases of FGA were identified in women, all causing OHSS. Mean age was 33.4 years at diagnosis. Abdominal pain, irregular periods, headache, and visual disturbances were reported at presentation by 100%, 71%, 57% and 43% of women, respectively. Three of seven women underwent ovarian surgery before FGA diagnosis. Six women underwent transsphenoidal surgery (TSS) with incomplete tumour resection in five of those, but all showed improvement or resolution in symptoms and biochemistry postoperatively.
Conclusion
FGA is a rare cause of spontaneous OHSS. TSS improves clinical and biochemical features of ovarian hyperstimulation in FGAs. Improved awareness of FGA will prevent inappropriate emergency ovarian surgery.
Date Issued
2023-10-01
Date Acceptance
2023-07-03
Citation
Clinical Endocrinology, 2023, 99 (4), pp.386-395
ISSN
0300-0664
Publisher
Wiley
Start Page
386
End Page
395
Journal / Book Title
Clinical Endocrinology
Volume
99
Issue
4
Copyright Statement
© 2023 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/37430451
Subjects
BOY
Endocrinology & Metabolism
FGA
functioning gonadotroph adenoma
GENE
HYPERSECRETION
INSIGHTS
LEUPROLIDE
LH
Life Sciences & Biomedicine
MUTATION
OHSS
ovarian hyperstimulation syndrome
Science & Technology
STIMULATING-HORMONE RECEPTOR
TUMOR
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2023-07-10