Evolution of clinical symptoms in a young woman with a recurrent gonadotroph adenoma causing ovarian hyperstimulation.

OBJECTIVE: To demonstrate the clinical course in a young female with gonadotroph adenoma causing ovarian stimulation. PATIENT AND METHODS: Our patient was a 23-year-old woman with a history of oligomenorrhea who had previously undergone bilateral ovarian wedge resection owing to the clinical appearance of polycystic ovaries. Two years later, she sought treatment for headache, galactorrhea, history of spotting and lower abdominal distension. FSH, LH, beta-LH, inhibin A and B, estradiol, prolactin (PRL), and beta-chorionic gonadotrophin (beta-CG) were measured, and the responses of FSH, LH and beta-LH to thyrotrophin-releasing hormone (TRH) were documented. Immunohistochemical analysis of the tumor tissue was performed after surgery. Five years after the trans-sphenoidal surgery, the patient again became oligomenorrheic. A large recurrent adenoma was diagnosed on CT one year later. Transvaginal ultrasound showed ovaries of normal size with multiple small cystic formations simulating a polycystic pattern, While the patient was awaiting surgery, a pituitary apoplexy occurred. Emergency decompressive surgery was performed and the patient fully recovered. RESULTS: Enlarged ovaries were found on ultrasound examination simulating a hyperstimulation-like pattern. At that time, elevated levels of FSH (13.4IU/l) and marginally elevated levels of beta-LH (1.43ng/ml) were found, whereas the level of LH (0.5IU/l) was subnormal. Plasma estradiol was markedly supranormal (6150pmol/l). Levels of inhibin A and B were elevated (326pg/ml and 588pg/ml respectively). The prolactin level (70ng/ml) was increased, whereas beta-chorionic gonadotrophin (beta-CG) was normal. Significantly increased FSH, LH, and beta-LH responses to TRH stimulation were documented. Pituitary macroadenoma was found on MRI scan and removed by trans-sphenoidal surgery. Immunohistochemical examination showed high positivity for beta-CG and LH, and slight positivity for FSH. Five years after the surgery, estradiol was elevated (1160pmol/l), whereas basal levels of LH (4.65IU/l) and FSH (3.98IU/l) were not suppressed. After the second operation, immunostaining of the adenoma tissue confirmed the previous findings. CONCLUSIONS: Measurement of gonadotrophins in our case did not prove to be a method for identifying a large recurrent gonadotroph pituitary adenoma. The sonographic ovarian imaging varied from a polycystic- to an ovarian hyperstimulation-like pattern during the evolution of the tumour.

Transvaginal sonographic assessment of premalignant and malignant changes in the endometrium in postmenopausal bleeding.

PURPOSE: We explored the value of transvaginal sonography as a screening technique for endometrial abnormalities. METHODS: Transvaginal sonography was used to evaluate the likelihood that an endometrial abnormality was present in a group of 103 women with postmenopausal bleeding. RESULTS: Sonographic findings showed a mean endometrial thickness of 6.2 mm in patients with endometrial atrophy, 12.4 mm in patients with simple hyperplasia, 13.4 mm in patients with complex hyperplasia, and 14.1 mm in patients with endometrial carcinoma. There was no statistically significant difference in endometrial thickness measurements between the hyperplasia and endometrial carcinoma groups. However, the difference between these groups and the endometrial atrophy group was statistically significant. The mean age was significantly higher for patients with endometrial carcinoma (62 years) than for the patients in the other groups. CONCLUSIONS: Our study shows that transvaginal sonography is a useful method of screening for endometrial abnormalities.

[The effect of the presence of the husband during childbirth]. / Ucinak nazocnosti muza pri porodu.

In the course of 1994 a particular number of deliveries were examined in the maternity ward of the Clinical Hospital "Sestre milosrdnice". Randomly a hundred pregnant women were chosen whose husbands were present at the childbirth. The same number of women delivered their babies without their husband's presence. The duration of labor was examined as well as APGAR score, threatening intrauterine asphyxia, uterine inertia, prolonged labor, induced labor, medical analgesia, and the frequency of cesarean section and vacuum extraction. In the group, in which the husband was present, the labor was shorter, the number of threatening intrauterine asphyxia cases and cesarean sections was smaller, but there were more induced deliveries. Contrary to all expectations, the uterine inertia with the administration of oxytocin was comparably present in both groups, the same as medical analgesia. Other above mentioned parameters were also comparably present in both groups. The level of labor analgesia was not examined in particular to avoid the subjective factor, and besides, the aim was to achieve the maximal possible analgesia. The results suggest the importance of husband's presence at childbirth. Apart from being a very important psychosocial factor, reducing the duration of labor as well as the frequency of threatening intrauterine asphyxia and cesarean section, it also directly affects the course and result of labor.