Ovarian Hyperstimulation Syndrome Caused by an FSH-Secreting Pituitary Adenoma

Odelia Cooper; Jordan L Geller; Shlomo Melmed

Disclosures

Nat Clin Pract Endocrinol Metab. 2008;4(4):234-238. 

In This Article

Treatment and Management

Surgical resection is the definitive and primary therapy for OHSS due to gonadotropin-secreting adenomas. Surgery results in normalization of gonadotropin and estradiol levels. Menstrual cycles resume and the ovaries revert to normal size with cyst remission. In those with recurrent tumors, radiation therapy may be required.

Medical therapies are generally not effective. In theory, one possible medical treatment would be the administration of a GnRH analog which would decrease FSH levels, thereby leading to resolution of OHSS; however, reports have actually shown a paradoxical increase in gonadotropin secretion in response to this treatment,[4,15,16,17,18,19,20] and in one case OHSS was induced after initiation of GnRH therapy with dramatic increases in FSH and estradiol levels.[21]

There are three reports of patients with OHSS who were initially treated medically. These patients presented with oligomenorrhea, abdominal distension, and enlarged multicystic ovaries. Estradiol levels were as high as 6,755 pmol/l, with elevated prolactin and FSH levels and suppressed LH levels. The three patients were treated with a dopamine agonist and two of the patients also received medroxyprogesterone. Ovarian volumes and hormonal values normalized. Eventually, however, the adenomas continued to grow and were resected, showing positive immunostaining for LH in two cases and for FSH in one case.[15,22]

After resection of a pituitary adenoma, patients are monitored annually with MRI, looking for evidence of a possible recurrence. Patients should also undergo hormonal testing 3 months after surgery to assess whether hypopituitarism is present. If there is evidence of a deficiency of any of the hormones of the pituitary axis, hormonal replacement therapy is initiated.

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