[Hypergonadotropic ovarian failure in three patients with pituitary hyperplasia]

Three patients with ovulatory disturbances associated with increased production of gonadotropins and normal excretion of estrogen were endocrinologically examined. Patient A was 25 years old and had irregular menstruation of 13 years' duration. Patients B and C were 32 and 36 years old, the former with secondary amenorrhea of 19 years' duration and the latter with one of 2 months. Endocrinological analyses revealed a markedly increased plasma concentration of both LH (greater than 117 mIU/ml) and FSH (greater than 113 mIU/ml) in all three patients. The plasma concentration of estradiol was over 56 pg/ml in A and C before medication, and in the other patient (case B) the plasma estradiol level rose to 53 pg/ml after the administration of clomiphene. There was excessive LH and FSH response in the LH-RH stimulation test. Episodic gonadotropin secretions were observed and two weeks' administration of estrogen plasma concentrations of LH and FSH were suppressed. Computerized tomography revealed a high density area about 9-11 mm in diameter in the sella turcica of all three patients. Patient A underwent surgery via the transsphenoidal approach. Histology shows pituitary hyperplasia. After operation, the elevated LH and FSH concentration decreased to below 30 mIU/ml and the plasma concentration of estradiol and progesterone was increased to 260 pg/ml and 2 ng/ml, respectively.