Studies on Pituitary-Gonadal Function in Patients with Cushing's Syndrome.

Odagiri, Emi; Yamanaka, Yukako; Ishiwatari, Naoko; Jibiki, Kazuko; Demura, Reiko; Demura, Hiroshi; Suda, Toshio; Shizume, Kazuo

doi:10.1507/endocrj1954.35.421

Cited by 20 publications

(16 citation statements)

References 14 publications

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“…Our patients had a median age at menarche of 13 yr (range, 10 -16 yr), with only 9% giving a history of OL, an incidence in keeping with the general population (26). Previous reports of GnRH tests in women with Cushing's syndrome have variously concluded the gonadotropin response to be poor (27,28), normal (29,30), or exaggerated (31)(32)(33). All of our patients had a normal FSH reserve, and a normal or exaggerated LH response was observed in 22 of 23 patients.…”

Section: Discussionsupporting

confidence: 46%

Menstrual Abnormalities in Women with Cushing’s Disease Are Correlated with Hypercortisolemia Rather Than Raised Circulating Androgen Levels

Lado-Abeal

Rodriguez-Arnao

Newell‐Price

et al. 1998

The Journal of Clinical Endocrinology &Amp; Metabolism

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Menstrual irregularity is a common complaint at presentation in women with Cushing's syndrome, although the etiology has been little studied. We have assessed 45 female patients (median age, 32 yr; range, 16 -41 yr) with newly diagnosed pituitary-dependent Cushing's syndrome. Patients were subdivided into 4 groups according to the duration of their menstrual cycle: normal cycles (NC; 26 -30 days), oligomenorrhea (OL; 31-120 days), amenorrhea (AM; Ͼ120 days), and polymenorrhea (PM; Ͻ26 days). Blood was taken at 0900 h for measurement of LH, FSH, PRL, testosterone, androstenedione, dehydroepiandrosterone sulfate, estradiol (E 2 ), sex hormone-binding globulin (SHBG), and ACTH; cortisol was sampled at 0900, 1800, and 2400 h. The LH and FSH responses to 100 g GnRH were analyzed in 23 patients. Statistical analysis was performed using the nonparametric Mann-Whitney U and Spearman tests.Only 9 patients had NC (20%), 14 had OL (31.1%), 15 had AM (33.3%), and 4 had PM (8.8%), whereas 3 had variable cycles (6.7%). By group, AM patients had lower serum E 2 levels (median, 110 pmol/L) than OL patients (225 pmol/L; P Ͻ 0.05) or NC patients (279 pmol/L; P Ͻ 0.05), and higher serum cortisol levels at 0900 h (800 vs.602 and 580 nmol/L, respectively; P Ͻ 0.05) and 1800 h (816 vs. 557 and 523 nmol/L, respectively; P Ͻ 0.05) and higher mean values from 6 samples obtained through the day (753 vs. 491 and 459 nmol/L, respectively; P Ͻ 0.05). For the whole group of patients there was a negative correlation between serum E 2 and cortisol at 0900 h (r ϭ Ϫ0.50; P Ͻ 0.01) and 1800 h (r ϭ Ϫ0.56; P Ͻ 0.01) and with mean cortisol (r ϭ Ϫ0.46; P Ͻ 0.05). No significant correlation was found between any serum androgen and E 2 or cortisol. The LH response to GnRH was normal in 43.5% of the patients, exaggerated in 52.1%, and decreased in 4.4%, but there were no significant differences among the menstrual groups. No differences were found in any other parameter.In summary, in our study 80% of patients with Cushing's syndrome had menstrual irregularity, and this was most closely related to serum cortisol rather than to circulating androgens. Patients with AM had higher levels of cortisol and lower levels of E 2 , while the GnRH response was either normal or exaggerated. Our data suggest that the menstrual irregularity in Cushing's disease appears to be the result of hypercortisolemic inhibition of gonadotropin release acting at a hypothalamic level, rather than raised circulating androgen levels. (J Clin Endocrinol Metab 83: 3083-3088, 1998)

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Section: Discussionsupporting

confidence: 46%

Menstrual Abnormalities in Women with Cushing’s Disease Are Correlated with Hypercortisolemia Rather Than Raised Circulating Androgen Levels

Lado-Abeal

Rodriguez-Arnao

Newell‐Price

et al. 1998

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…As is well known, this re-confirmed that hypercortisolism itself disturbs the hypothalamic-pituitary-gonadal axis in Cushing's disease [27][28][29][30][31].…”

Section: Function Of Anterior Pituitary Hormonessupporting

confidence: 69%

Effect of Surgery on Gonadal Function of Premenopausal Women with Pituitary Adenomas Other Than Prolactinomas.

et al. 1996

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Abstract. The effects of surgery on pituitary-gonadal function were investigated in women with pituitary adenomas other than prolactinomas. The subjects were 46 women of premenopausal age with a pituitary adenoma.Twenty tumors were GH producing, 19 were nonfunctioning, and 7 were adrenocorticotropin producing adenomas. The surgery was performed mainly via the transsphenoidal route, with the aim of eradicating the tumor and preserving pituitary function. The menstrual cycle was preserved postoperatively in 9 out of 10 (90%) patients with regular preoperative menstruation. Menstrual disturbance was seen in 36 (78.3%) cases preoperatively. The causative factors for menstrual disturbance were gonadotropin impairment and hyperprolactinemia in GH producing and nonfunctioning adenoma. Excessive hormonal secretion itself is a major causative factor for menstrual disturbance in GH and ACTH producing adenoma. Regular menstruation was restored following surgery in 20 out of 36 (55.6%) patients with menstrual problems. The predicting factors for postoperative recovery of menstruation are: size of adenoma less than 40 mm, period of amenorrhea less than 5 years, and preoperatively preserved gonadotropin secretion. In addition, preoperative hyperprolactinemia was also a predicting factor in women with nonfunctioning adenoma. Thus, even in patients with pituitary adenomas other than prolactinoma, the restoration of menstruation is highly achievable when surgery is performed with attention to preserving pituitary function.

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“…Unlike women with PCOS, many women with Cushing's syndrome have hypothalamic-pituitary suppression of gonadotropin secretion, often leading to a reduction of serum estradiol, LH, and FSH levels (279,280). An elevation of T in the blood has been reported in one half of patients with Cushing's syndrome (279,280).…”

Section: Cushing's Syndromementioning

confidence: 99%

The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report

Azziz

Carmina

Dewailly

et al. 2009

Fertility and Sterility

1,760

1,103

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Studies on Pituitary-Gonadal Function in Patients with Cushing's Syndrome.

Cited by 20 publications

References 14 publications

Menstrual Abnormalities in Women with Cushing’s Disease Are Correlated with Hypercortisolemia Rather Than Raised Circulating Androgen Levels

Menstrual Abnormalities in Women with Cushing’s Disease Are Correlated with Hypercortisolemia Rather Than Raised Circulating Androgen Levels

Effect of Surgery on Gonadal Function of Premenopausal Women with Pituitary Adenomas Other Than Prolactinomas.

The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report

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