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Successful Pregnancy after Bromocriptine Therapy in an Anovulatory Woman Complicated with Ovarian Hyperstimulation Caused by Follicle-Stimulating Hormone-Producing Plurihormonal Pituitary Microadenoma

Departments of Obstetrics and Gynecology and Maternal and Perinatal Medicine (Y.M., H.A., S.M.), and Department of Neurosurgery (K.S.), Nagoya University Graduate School of Medicine, Nagoya 466-8550; Division of Pathology (T.N.), Clinical Laboratory, Nagoya University Hospital, Nagoya 466-8560; and Departments of Neurosurgery (I.T.) and Obstetrics and Gynecology (H.F., K.M.), Anjo Kosei Hospital, Anjo, Aichi 446-8602, Japan

Address all correspondence and requests for reprints to: Hisao Ando, M.D., Ph.D., Department of Obstetrics and Gynecology, Nagoya University School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. E-mail: ando{at}med.nagoya-u.ac.jp.

Abstract

Gonadotropin-producing pituitary adenomas are extremely rare in reproductive-age women. We report here a case of gonadotroph microadenoma with ovarian hyperstimulation. It was found in a 29-yr-old infertile Japanese woman with enlarged multicystic ovaries. The patient had an elevated basal serum estradiol level (up to 6755 pM, or 1840 pg/ml). Serum FSH and prolactin were mildly elevated (15.4 IU/liter, 1.4 nM or 31.4 ng/ml), whereas LH was low (0.5 IU/liter). The FSH level was paradoxically elevated in response to TRH administration. Dynamic magnetic resonance imaging revealed a pituitary microadenoma. Daily administration of bromocriptine, a dopamine agonist, normalized the ovarian size, and the patient ovulated naturally. She conceived after 3 months of bromocriptine therapy and delivered a normal child. She underwent elective transsphenoidal pituitary surgery, 3 yr after the delivery. Immunostaining of the resected tumor showed that 80% and less than 5% of the tumor cells stained for FSH-ß and prolactin, respectively. Furthermore, RT-PCR suggested that dopamine type 2 receptor was expressed in the adenoma. Gonadotroph microadenoma should be considered in women with spontaneous ovarian hyperstimulation, even if they have no neurological symptoms or marked pituitary enlargement. In such cases, bromocriptine therapy may be an alternative to pituitary surgery.

Footnotes

This work was supported in part by a grant-in-aid for Scientific Research (to H.A. and to S.M.) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

Abbreviations: CT, Computed tomography; D2R, dopamine type 2 receptor; 3D, three-dimensional; MRI, magnetic resonance imaging; PRL, prolactin.

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