1/7. Ovarian hyperstimulation without elevated serum estradiol associated with pure follicle-stimulating hormone-secreting pituitary adenoma.We report a unique case of a 28-yr-old woman with a gonadotroph adenoma secreting FSH, presented with ovarian hyperstimulation, without elevation of serum estradiol. She presented with abdominal pain and large ovaries (both 10 cm in diameter) with multiple follicular cysts shortly after discontinuing oral contraceptive pills. She had a supranormal PRL level of 71 microg/liter (normal, <20), FSH of 8.4-9.2 IU/liter (normal for follicular phase, 2.4-10), LH of 0.01 IU/liter (normal, 1.6-9.3), estradiol of 108 pmol/liter (normal for follicular phase, 80-790), and free alpha-subunit level of 0.11 microg/liter (normal, <1.8). A nuclear magnetic resonance study revealed invasive pituitary macroadenoma, 30 mm in diameter. dopamine agonist (cabergoline) treatment normalized serum PRL but had no affect on FSH levels. A transsphenoidal surgery was performed, and most of the adenoma was resected. One month after surgery the patient resumed menstruation, and the hormonal profile included serum FSH of 6.3 IU/liter, LH of 2.1 IU/liter, estradiol of 156 pmol/liter, and PRL of 10 microg/liter. The excised adenoma tissue exhibited intense immunostaining for FSH and secreted this hormone to culture medium. Stimulation with TRH (both in vivo preoperatively and in vitro study of the excised tumor) had no effect on FSH secretion from the adenoma. estradiol did not suppress FSH release from cultured adenoma cells. Patient serum samples showed significant FSH bioactivity when tested in a human granulosa cell line. This case is remarkable because the ovarian hyperstimulation related to the FSH-secreting adenoma was not associated with high levels of serum estradiol, probably due to insufficient LH production by the normal pituitary. Thus, it supports the two-cell, two-gonadotropin theory, that both FSH and LH are necessary for normal ovarian estrogen production.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
2/7. Didelphic uterus and unilaterally imperforate double vagina as an unusual presentation of right lower-quadrant abdominal pain.Imperforate hymen should be considered in girls of menarcheal age with a history of amenorrhea and vague abdominal discomfort, particularly if associated with symptoms of urinary obstruction or constipation. patients may present with severe dysmenorrhea and localized pain mimicking appendicitis if hematocolpometra is due to unilaterally imperforate hymen with duplicate vagina and didelphic uterus. Although this condition is exceedingly rare, the case presented stresses the importance of a careful history and physical examination of an adolescent girl presenting with symptoms of abdominal pain associated with menstruation.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
3/7. An unusual case of syncope.We describe the case of a woman, who had previously undergone tubal sterilization, and later experienced two episodes of orthostatic hypotension during menstruation, as a result of an ectopic pregnancy.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
4/7. Primary omental pregnancy: case report.Omental pregnancy is a very rare form of ectopic pregnancy. Here we presented a case of primary omental pregnancy diagnosed at surgical exploration. A 28 year old woman submitted with severe abdominal pain, without any delay of menstruation. history of the patient revealed no use of contraceptive method. There was no gestational sac in the endometrial cavity and no tubal ring in the adnexa, but free peritoneal fluid in the pouch of Douglas was detected at ultrasonography. laparotomy was done according to pre-operative diagnosis of ruptured tubal pregnancy. Bilateral tubes and ovaries were intact; omental pregnancy was detected and partial omentectomy was performed. Although 16 cases of omental pregnancy (mostly secondary) were reported in the literature, herein we describe a primary omental pregnancy without adnexial involvement.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
5/7. Regular abdominal pain and fever in each menstruation onset: an unusual menses-associated familial Mediterrenean fever attacks and a favor result on colchicine treatment.We present a 38-year-old woman suffering from regular abdominal pain and fever only in each menstruation onset for 7 years. The clinical symptoms, along with inflammatory findings during painful attacks, the beneficial effect of colchicine and genetic mutation (M694 V and M680I) supported the diagnosis of familial mediterranean fever (FMF). A literature review indicated that FMF attacks occurring only during menstruation are rarely seen. This clinical picture may be confused with gynecological disorders especially in the people of Mediterranean origin.- - - - - - - - - - ranking = 6keywords = menstruation (Clic here for more details about this article) |
6/7. Laparoscopic approach to an endometriotic vault fistula causing posthysterectomy "menstruation".endometriosis is a commonly prevalent disease but can include rare complaints posing a challenge to surgical treatment. We describe an unreported cause of menstruation after hysterectomy, which was revealed as an endometriotic tubo-ovarian mass that fistulated into the vaginal vault. A 37-year-old woman experienced monthly vaginal bleeding after hysterectomy. At laparoscopy a tubo-ovarian endometriotic mass was revealed with a fistula into the vaginal vault. The mass was adherent to the left ureter and the sigmoid colon. Laparoscopic excision of the mass and fistula after ureterolysis and bowel dissection was performed. This case describes an unreported cause of posthysterectomy menstruation. The management outlines the optimal surgical management of laparoscopic techniques combined with vaginal access to achieve complete excision with minimal patient morbidity.- - - - - - - - - - ranking = 6keywords = menstruation (Clic here for more details about this article) |
7/7. Acute urinary retention caused by a unilateral hematometra.We describe a unilateral hematometra with an associated hematosalpinx causing acute retention of urine in a female adolescent. Normal menstruation had occurred from the uterine cavity on the unaffected side. Treatment was by abdominal metroplasty with complete excision of the uterine septum and a terminal cuff salpingostomy. Urological investigation revealed ipsilateral renal agenesis.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |