Two patients with hypergonadotropic ovarian failure due to pituitary hyperplasia

Two patients with hypergonadotropic ovarian failure were examined. Plasma levels of LH and FSH were markedly elevated to over 113 mIU/mL (Second International Reference Preparation--human menopausal gonadotropin standard), but the FSH/LH ratio was 1 or less in both women. The plasma estradiol (E2) level was 65 pg/mL in one woman before medication, and in the other increased from below 25 to 130 pg/mL after large doses of clomiphene citrate treatment. The pituitary tissues removed by transsphenoidal surgery showed hyperplasia with numerous cells immuno-histochemically positive for LH and FSH. After surgery, the elevated plasma gonadotropins decreased and plasma E2 levels increased. Human menopausal gonadotropin after clomiphene citrate treatment induced ovulation in one patient, and cyclic administration of estrogen and progesterone induced ovulation in the other. These results suggest that elevated gonadotropins may suppress ovarian function in some cases.