The clinical manifestations of gonadotroph
adenomas are almost always neurological, consequences of their large size, and are rarely endocrinological. We report an exception, a 39-yr-old woman whose gonadotroph
adenoma caused supranormal serum concentrations of FSH, which resulted in the development of multiple
ovarian cysts, persistent elevation of her serum
estradiol concentration, and
endometrial hyperplasia. She initially presented because of
amenorrhea at age 30 yr and was treated for an intrasellar mass by transsphenoidal surgery at age 31 yr and again at age 36 yr. Before and after the second operation she had persistently supranormal plasma
estradiol concentrations (> 1840 pmol/L) and
endometrial hyperplasia. When she was evaluated at age 39 yr, transvaginal ultrasound showed multiple
ovarian cysts and endometrial thickening. Her plasma
estradiol level was markedly supranormal (2160 pmol/L), FSH was mildly supranormal (17.8 IU/L), and alpha-subunit was markedly supranormal (23.3 micrograms/L). Characteristic of gonadotroph
adenomas, her
LH beta level increased by 69% in response to TRH. Neither FSH nor alpha-subunit decreased in response to administration of the
GnRH antagonist,
Nal-Glu-GnRH (5 mg/12 h for 4 weeks). Excised
adenoma tissue exhibited morphological features of a gonadotroph
adenoma. This patient appears to be unique, in that her gonadotroph
adenoma caused slightly, but persistently, supranormal concentrations of FSH, which caused ovarian stimulation, including supranormal plasma
estradiol concentrations, multiple
ovarian cysts, and
endometrial hyperplasia. We propose that gonadotroph
adenomas be considered in the differential diagnosis of patients who have this constellation of abnormalities.