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application/pdf, International Journal of Heat and Fluid Flow. 2020, 82, P.108541

Tsuyoshi Baba,1 Toshiaki Endo,1 Keiko Ikeda,1 Ayumi Shimizu,1 Miyuki Morishita,1 Yoshika Kuno,1 Hiroyuki Honnma,2 Tamotsu Kiya,3 Shin-ichi Ishioka,1 Tsuyoshi Saito11Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, 2Asada Ladies Clinic, Kasugai, Aichi, 3Ena Ladies Clinic, Ishikari, Hokkaido, JapanAbstract: This report presents an unusual case of Sertoli-stromal cell tumor and polycystic ovary syndrome successfully treated with weight reduction and an insulin-sensitizing agent. A 22-year-old woman, gravida 0, para 0, visited our hospital for the first time with a 12-year history of secondary amenorrhea and hypertrichosis. Transvaginal ultrasonography revealed a solid tumor in the right ovary. Right salpingo-oophorectomy was performed and pathological examination confirmed a Sertoli-stromal cell tumor. The patient's serum androgen levels declined postoperatively, but remained above normal. Pioglitazone treatment for 6 months also significantly reduced serum androgen levels, but they still remained above normal. However, after losing 12 kg of body weight, the patient's serum androgen levels declined to normal, and spontaneous menstruation became regular. Weight reduction with pioglitazone is an effective means of treating hyperandrogenism.Keywords: etiology, hyperandrogenism, pioglitazone, polycystic ovary syndrome, Sertoli-stromal cell tumor, weight reduction

Mika Kanaya,1 Tsuyoshi Baba,2 Yoshimitsu Kitajima,2 Keiko Ikeda,2 Ayumi Shimizu,2 Miyuki Morishita,2 Hiroyuki Honnma,3 Toshiaki Endo,2 Tsuyoshi Saito21Mika Ladies Clinic, 2Department of Obstetrics and Gynecology, Sapporo Medical University, School of Medicine, 3Kamiya Ladies Clinic, Sapporo, JapanContext: Follicle-stimulating hormone (FSH)-secreting pituitary adenoma is usually a nonfunctioning tumor, but in rare cases it may develop into ovarian hyperstimulation. Several reports have revealed that serum FSH levels are normal to slightly high in patients with combined FSH-secreting pituitary adenoma with ovarian hyperstimulation. This finding is different from iatrogenic ovarian hyperstimulation syndrome (OHSS), which is associated with extremely high levels of FSH.Objective: To describe the clinical course of two patients who developed OHSS from FSH-secreting pituitary adenoma.Results: Endocrine studies of the two cases revealed that FSH levels were normal or slightly increased, but luteinizing hormone levels were low to undetectable. Their estradiol (E2) levels were intriguing: levels fluctuated drastically over 6 weeks in Case 1, but stayed flat in Case 2. Ultrasonographic examinations showed bilaterally enlarged multicystic ovaries, and magnetic resonance imaging indicated pituitary tumors. Transsephenoidal resection of the tumors ameliorated the symptoms and pathological diagnosis revealed FSH-secreting pituitary adenomas.Conclusion: As is not the case in iatrogenic OHSS, even a small to moderate amount of FSH stimulation, which is continuously secreted by a pituitary adenoma, can cause ovarian hyperstimulation. Although FSH-secreting pituitary adenoma can cause ovarian hyperstimulation, an extremely high amount of E2 biosynthesis from granulosa cells seldom occurs.Keywords: pituitary adenoma, OHSS, FSH, estradiol, luteinizing hormone