1/5. 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) |
2/5. Recurrent hemoperitoneum in women receiving continuous ambulatory peritoneal dialysis.Of 27 women in the reproductive age group receiving continuous ambulatory peritoneal dialysis for more than 3 months, 4 of 7 who menstruated developed recurrent hemoperitoneum. Tubal ligation had been done in 3 of these 4 women. There were 37 episodes of hemoperitoneum; 22 occurred at midcycle and 15 with menstruation. One patient required repeated blood transfusion, but after oral anovulant therapy no further bleeding occurred and no transfusion was required. Two patients needed laparotomy: one for heavy intraperitoneal bleeding originating from a luteal cyst, and the other for severe lower abdominal pain from follicular and luteal cysts. Ultrasound examinations suggested the presence of small ovarian cysts in the two remaining patients. Recurrent midcycle hemoperitoneum in women on continuous ambulatory peritoneal dialysis may be triggered by ovulation and associated ovarian cyst formation. Suppression of ovulation should be considered.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
3/5. Symptoms associated with menstruation.Symptoms associated with menstruation during the teenage and young adult years may represent a spectrum of possibilities varying from a relatively benign deviation from normal to a serious life-threatening disease. Nevertheless, even for the young woman found to be without serious disease, menstrual problems have special meaning associated with the fear of being different from peers, concern about being less than complete or wholesome, and anxiety regarding future functioning as a normal woman. The physician must be aware of the adolescent's sensitivity in this area. Her apprehension should influence the manner in which the various abnormalities of menstruation are evaluated and managed. The physician must understand and appreciate the potential for profound emotional effects and psychological implications of menstrual conditions. The manner in which we care for the adolescent with menstrual symptoms will determine to a significant degree how successfully the patient will cope with abnormalities of menstruation.- - - - - - - - - - ranking = 7keywords = menstruation (Clic here for more details about this article) |
4/5. Hemorrhagic ovarian cysts in patients on anticoagulation therapy: CT findings.OBJECTIVE: hemorrhage into ovarian cysts is a frequent and potentially life-threatening complication in women on chronic anticoagulation therapy. This article presents the CT findings of three surgically confirmed cases of symptomatic hemorrhagic ovarian cysts associated with anticoagulation therapy. MATERIALS AND methods: There were two cases of unruptured hemorrhagic ovarian cysts: a patient with two corpus luteum cysts of menstruation and a patient with a serous cystadenoma. RESULTS: Each mass had a rounded central region of high attenuation (76, 62, and 50 HU) representing blood that was surrounded by fluid density. The third case was a hemorrhagic corpus luteum cyst of menstruation with rupture and hemoperitoneum. CONCLUSION: Hemorrhagic ovarian cysts should be included in the differential diagnosis of high-attenuation adnexal masses, especially in patients on anticoagulation therapy and in those with abrupt onset of pelvic pain.- - - - - - - - - - ranking = 2keywords = menstruation (Clic here for more details about this article) |
5/5. Vaginal bleeding: presenting symptom of acquired primary hypothyroidism in a seven year-old girl.A seven year-old girl who presented with vaginal bleeding and a right ovarian cyst was diagnosed as having acquired primary hypothyroidism. She had menstruation in spite of a delayed bone age, absence of pubertal growth spurt and lack of adrenarche. Elevated levels (age-matched) of gonadotropins, normal levels of estradiol, and hyperprolactinemia were documented. The clinical and laboratory findings were reversed by thyroxin treatment. The clinical presentation in this case, and other similar descriptions in the literature, support the mechanism of pseudo-precocious puberty in untreated hypothyroidism.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |