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[Resistant ovary syndrome. Case report].

Fred Morgan Ortiz¹, Cuauhtémoc Meza Mendoza, Isabel Beltrán Lugo

¹Departamento de Ginecología y Obstetricia, Coordinación Universitaria del Hospital Civil de Culiacán, Universidad Autónoma de Sinaloa, México. fmorganortiz@hotmail.com

Ginecologia Y Obstetricia De Mexico

|October 5, 2011

Summary

Resistant ovary syndrome, a cause of hypergonadotropic hypogonadism, is characterized by elevated gonadotropins despite ovarian resistance. This case highlights abundant primordial follicles without mature ones in a patient with primary amenorrhea.

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Area of Science:

Endocrinology
Reproductive Medicine
Genetics

Background:

Hypergonadotropic hypogonadism presents with elevated gonadotropins, often leading to suspected ovarian failure.
Differential diagnoses include chromosomal abnormalities, intrinsic ovarian failure, and gonadotropin receptor resistance, primarily Follicle-Stimulating Hormone (FSH) resistance.

Observation:

A 16-year-old female presented with primary amenorrhea and underdeveloped secondary sexual characteristics.
Physical examination revealed Tanner Stage I development for breasts and pubic/axillary hair. Ultrasound showed a small uterus and ovaries.
Laboratory results indicated high Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) levels, with prepubertal levels of estradiol and testosterone. Prolactin, Thyroid-Stimulating Hormone (TSH), triiodothyronine (T3), and thyroxine (T4) were normal. Karyotype was normal female.

Findings:

Diagnostic laparoscopy revealed small ovarian slips.
Ovarian biopsy demonstrated abundant primordial follicles and spindle cell stroma, but lacked primary and antral follicles.
These findings integrated the diagnosis of resistant ovary syndrome.

Implications:

Resistant ovary syndrome should be considered in patients with primary amenorrhea and hypergonadotropic hypogonadism.
The presence of primordial follicles suggests an intrinsic ovarian issue rather than complete agenesis.
Further research into the mechanisms and management of resistant ovary syndrome is warranted.