Ovarian Hyperstimulation Caused by Gonadotroph Pituitary Adenoma – Review

Abstract

Ovarian hyperstimulation syndrome (OHSS) occurs mostly as an iatrogenic complication of assisted reproductive technology. Gonadotroph pituitary adenomas are rarely associated with OHSS. To the authors' knowledge, to date only 30 cases of spontaneous ovarian stimulation associated with gonadotroph adenomas have been reported in women and only 2 in children. The most common symptoms in such cases included menstrual disturbances, abdominal or pelvic pain, abdominal distension and increased girth. Galactorrhea, nausea and vomiting were also reported. Neurological symptoms occurred when the size of the pituitary tumor reached at least 20 mm. Transvaginal ultrasound examination usually demonstrated enlarged multicystic ovaries. MRIs of the pituitary revealed macroadenomas up to 61 mm in maximum diameter. The hormonal profiles of the reported cases showed normal or elevated FSH levels, suppressed LH levels, elevated estradiol levels and supranormal concentrations of prolactin. Transsphenoidal surgery is the therapy of choice, however other treatment modalities can be utilized in selected cases (Adv Clin Exp Med 2015, 24, 4, 695-703).

Follicle-Stimulating Hormone-Producing Pituitary Adenoma: A Case Report and Review of the Literature

“…The characteristic hormonal profile in reported cases of gonadotropin-secreting OHSS, including in our case, shows normal-to-elevated FSH levels, suppressed LH levels, elevated estradiol levels, and supranormal concentrations of prolactin, mostly due to pituitary stalk compression (10). Cases with normal FSH concentrations capable of inducing OHSS could likely be due to enhanced FSH bioactivity (10). Low LH levels typically seen are thought to be primarily due to estrogen-induced negative feedback or compression of normal pituitary tissue.…”

“…A 2017 paper (13) reviewing the World Health Organization classification of pituitary adenomas discusses how tumor subtyping, assessment of tumor proliferation potentials through mitotic count and Ki-67 index, as well as clinical parameters such as tumor invasion should be considered for detecting clinically aggressive adenomas. The characteristic hormonal profile in reported cases of gonadotropin-secreting OHSS, including in our case, shows normal-to-elevated FSH levels, suppressed LH levels, elevated estradiol levels, and supranormal concentrations of prolactin, mostly due to pituitary stalk compression (10). Cases with normal FSH concentrations capable of inducing OHSS could likely be due to enhanced FSH bioactivity (10).…”

A proteomic analysis identifies candidate early biomarkers to predict ovarian hyperstimulation syndrome in polycystic ovarian syndrome patients

“…Risk factors that relate to the development of OHSS include young age, low body weight, PCOS, previous episodes of OHSS, multiple pregnancy, rapidly rising estradiol (E2) levels and follicle number (>20–25) (5–7). Serum levels of vascular endothelial growth factor (VEGF) in follicular fluid, pleural effusion and ascites are higher in OHSS patients compared with healthy people (8).…”

Management of ovarian hyperstimulation syndrome with abdominal compartment syndrome, based on intravesical pressure measurement

“…Ovarian hyperstimulation syndrome (OHSS) is primarily an iatrogenic disease that is characterized by an exaggerated response to ovulation induction therapy . This iatrogenic complication results from a loss of control of ovarian stimulation and can occur with any agent that is used to induce ovulation . Ovarian hyperstimulation syndrome consists of a variety of symptoms and signs, including ovarian enlargement, third‐space fluid collection, hemoconcentration, pleural effusion, ascites, and abdominal discomfort subsequent to increased vascular permeability …”

“…1 This iatrogenic complication results from a loss of control of ovarian stimulation and can occur with any agent that is used to induce ovulation. [1][2][3][4] Ovarian hyperstimulation syndrome consists of a variety of symptoms and signs, including ovarian enlargement, thirdspace fluid collection, hemoconcentration, pleural effusion, ascites, and abdominal discomfort subsequent to increased vascular permeability. 1,2,5 The treatment of OHSS usually requires i.v.…”