Menstrual Abnormalities in a Woman with Acth-Dependent Pituitary Macroadenoma Mimicking Polycystic Ovary Syndrome
Objective: Here, we present a case of ACTH-dependent pituitary macroadenoma (Cushing's disease) resulting in secondary amenorrhea mimicking polycystic ovary syndrome (PCOS). Case Report: A 20-year-old nulligravid woman had been suffering from oligomenorrhea, amenorrhea, and moderate hirsutism s...
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| Format: | Article |
| Language: | English |
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Elsevier
2006-06-01
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| Series: | Taiwanese Journal of Obstetrics & Gynecology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1028455909602217 |
| _version_ | 1818986914484584448 |
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| author | Chun-Cheng Liao Shih-Yi Lin Hsin-Wang Lin Kuang-Hua Chen Lan-Hua Chang Shun-Tien Chen John Wang |
| author_facet | Chun-Cheng Liao Shih-Yi Lin Hsin-Wang Lin Kuang-Hua Chen Lan-Hua Chang Shun-Tien Chen John Wang |
| author_sort | Chun-Cheng Liao |
| collection | DOAJ |
| description | Objective: Here, we present a case of ACTH-dependent pituitary macroadenoma (Cushing's disease) resulting in secondary amenorrhea mimicking polycystic ovary syndrome (PCOS).
Case Report: A 20-year-old nulligravid woman had been suffering from oligomenorrhea, amenorrhea, and moderate hirsutism since the age of 18 years. She visited a gynecologic clinic where PCOS was impressed according to the clinical manifestation and ultrasound finding. The patient responded to medication in the 1st year, but gradually failed to induce menses. She was advised to visit the endocrinology department for secondary amenorrhea and endocrine survey. Physical examination revealed central obesity, supraclavicle fatpad, abdominal striae, and myopathy of four limbs. Endocrine studies revealed: serum prolactin 21 ng/mL (3.0-20 ng/mL), FSH 5.69 mIU/mL (3.4-10.0 mIU/mL), LH 1.01 mIU/mL (1.1-11.6 mIU/mL), E2 < 20 pg/mL (follicular phase 53-258 pg/mL), ACTH 110 pg/mL (0-46.0 pg/mL), cortisol 26.7 μg/dL at 8 a.m. (5.0-25 μg/dL), cortisol 21.3 μg/dL at 11 p.m. (half of normal morning value). Right pituitary macroadenoma was diagnosed through a series of dexamethasone tests and MRI. The patient received staging surgery including transsphenoidal adenomectomy and right frontotemporal craniotomy. As a result, the patient's physical condition gradually improved, and her menstrual cycle became regular with medication after the operation in the outpatient follow-up.
Conclusion: PCOS is a common disease resulting in secondary amenorrhea. However, Cushing's syndrome resulting from pituitary macroadenoma should also be considered. Therefore, a careful history, observation, physical examination, and endocrine studies can differentiate between patients with PCOS and Cushing's disease. |
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| format | Article |
| id | doaj.art-c775c4e3e20147eda55fd4e7bd54537c |
| institution | Directory Open Access Journal |
| issn | 1028-4559 |
| language | English |
| last_indexed | 2024-12-20T18:58:22Z |
| publishDate | 2006-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Taiwanese Journal of Obstetrics & Gynecology |
| spelling | doaj.art-c775c4e3e20147eda55fd4e7bd54537c2022-12-21T19:29:27ZengElsevierTaiwanese Journal of Obstetrics & Gynecology1028-45592006-06-0145217617910.1016/S1028-4559(09)60221-7Menstrual Abnormalities in a Woman with Acth-Dependent Pituitary Macroadenoma Mimicking Polycystic Ovary SyndromeChun-Cheng Liao0Shih-Yi Lin1Hsin-Wang Lin2Kuang-Hua Chen3Lan-Hua Chang4Shun-Tien Chen5John Wang6Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, TaiwanDepartment of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, TaiwanDepartment of Obstetrics and Gynecology, Taichung Armed Forces General Hospital, Taichung, TaiwanDepartment of Obstetrics and Gynecology, Taichung Armed Forces General Hospital, Taichung, TaiwanDepartment of Obstetrics and Gynecology, Taichung Armed Forces General Hospital, Taichung, TaiwanDepartment of Family Medicine, Taichung Armed Forces General Hospital, Taichung, TaiwanDepartment of Pathology, Taichung Veterans General Hospital, Taichung, TaiwanObjective: Here, we present a case of ACTH-dependent pituitary macroadenoma (Cushing's disease) resulting in secondary amenorrhea mimicking polycystic ovary syndrome (PCOS). Case Report: A 20-year-old nulligravid woman had been suffering from oligomenorrhea, amenorrhea, and moderate hirsutism since the age of 18 years. She visited a gynecologic clinic where PCOS was impressed according to the clinical manifestation and ultrasound finding. The patient responded to medication in the 1st year, but gradually failed to induce menses. She was advised to visit the endocrinology department for secondary amenorrhea and endocrine survey. Physical examination revealed central obesity, supraclavicle fatpad, abdominal striae, and myopathy of four limbs. Endocrine studies revealed: serum prolactin 21 ng/mL (3.0-20 ng/mL), FSH 5.69 mIU/mL (3.4-10.0 mIU/mL), LH 1.01 mIU/mL (1.1-11.6 mIU/mL), E2 < 20 pg/mL (follicular phase 53-258 pg/mL), ACTH 110 pg/mL (0-46.0 pg/mL), cortisol 26.7 μg/dL at 8 a.m. (5.0-25 μg/dL), cortisol 21.3 μg/dL at 11 p.m. (half of normal morning value). Right pituitary macroadenoma was diagnosed through a series of dexamethasone tests and MRI. The patient received staging surgery including transsphenoidal adenomectomy and right frontotemporal craniotomy. As a result, the patient's physical condition gradually improved, and her menstrual cycle became regular with medication after the operation in the outpatient follow-up. Conclusion: PCOS is a common disease resulting in secondary amenorrhea. However, Cushing's syndrome resulting from pituitary macroadenoma should also be considered. Therefore, a careful history, observation, physical examination, and endocrine studies can differentiate between patients with PCOS and Cushing's disease.http://www.sciencedirect.com/science/article/pii/S1028455909602217ACTH-dependent pituitary macroadenomaCushing's diseasepolycystic ovary syndromesecondary amenorrhea |
| spellingShingle | Chun-Cheng Liao Shih-Yi Lin Hsin-Wang Lin Kuang-Hua Chen Lan-Hua Chang Shun-Tien Chen John Wang Menstrual Abnormalities in a Woman with Acth-Dependent Pituitary Macroadenoma Mimicking Polycystic Ovary Syndrome Taiwanese Journal of Obstetrics & Gynecology ACTH-dependent pituitary macroadenoma Cushing's disease polycystic ovary syndrome secondary amenorrhea |
| title | Menstrual Abnormalities in a Woman with Acth-Dependent Pituitary Macroadenoma Mimicking Polycystic Ovary Syndrome |
| title_full | Menstrual Abnormalities in a Woman with Acth-Dependent Pituitary Macroadenoma Mimicking Polycystic Ovary Syndrome |
| title_fullStr | Menstrual Abnormalities in a Woman with Acth-Dependent Pituitary Macroadenoma Mimicking Polycystic Ovary Syndrome |
| title_full_unstemmed | Menstrual Abnormalities in a Woman with Acth-Dependent Pituitary Macroadenoma Mimicking Polycystic Ovary Syndrome |
| title_short | Menstrual Abnormalities in a Woman with Acth-Dependent Pituitary Macroadenoma Mimicking Polycystic Ovary Syndrome |
| title_sort | menstrual abnormalities in a woman with acth dependent pituitary macroadenoma mimicking polycystic ovary syndrome |
| topic | ACTH-dependent pituitary macroadenoma Cushing's disease polycystic ovary syndrome secondary amenorrhea |
| url | http://www.sciencedirect.com/science/article/pii/S1028455909602217 |
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