Diagnosis of pituitary gonadotroph adenomas in reproductive-aged women.

OBJECTIVE To describe the clinical symptoms associated with the diagnosis of pituitary gonadotroph adenoma in premenopausal women. DESIGN Report of three separate cases. SETTING University medical center. PATIENT(S) Three patients: a 31-year-old woman with primary infertility, recurrent adnexal masses, and highly elevated estradiol level; a 30-year-old woman with recurrent multicystic ovaries following multiple cystectomies and transvaginal cyst aspirations, and elevated estradiol level; a 43-year-old woman with bilateral complex cystic adnexal masses and an elevated estradiol level, who underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a suspected granulosa cell tumor. INTERVENTION(S) Transsphenoidal resection of a pituitary mass. MAIN OUTCOME MEASURE(S) Serum estradiol, FSH, and LH levels; transvaginal ultrasonography of the ovaries; histologic examination of pituitary tumors. RESULT(S) Transsphenoidal resection of pituitary adenomas resulted in normalization of serum estradiol and FSH levels and resolution of adnexal masses in two of the women. CONCLUSION(S) Pituitary gonadotroph adenoma must be considered in the differential diagnosis in reproductive-aged women presenting with the clinical symptom triad of new onset oligomenorrhea, bilateral cystic adnexal masses, and elevated estradiol and FSH levels with suppressed levels of LH; timely diagnosis may prevent unnecessary and potentially damaging surgical procedures.