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Massive Ovarian Growth in a Woman With Severe Insulin-Resistant Polycystic Ovary Syndrome Receiving GnRH Analogue.
- Source :
-
The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2019 Jul 01; Vol. 104 (7), pp. 2796-2800. - Publication Year :
- 2019
-
Abstract
- Context: Ovarian hyperandrogenism from polycystic ovary syndrome (PCOS) and hyperinsulinemia from insulin resistance are modulators of ovarian follicle development. We report on a woman with PCOS and hyperandrogenism and severe insulin resistance from metabolic syndrome who received long-term GnRH analogue therapy preceding bilateral salpingo-oophorectomy for massive ovarian enlargement. Ovarian histological examination showed proliferating granulosa cells within antral follicles coexistent with serous cystadenofibromas, demonstrating a unique link between hyperinsulinemia and granulosa cell mitogenesis.<br />Case Description: A 30-year-old woman with PCOS with hyperandrogenism, severe insulin resistance from metabolic syndrome, and nonalcoholic steatohepatitis experienced abdominal pain from bilaterally enlarged ovaries. She had previously experienced a pulmonary embolism while taking oral contraceptives and hepatotoxicity from metformin and spironolactone therapies. Long-term GnRH analogue therapy to induce pituitary desensitization to GnRH successfully decreased gonadotropin-dependent steroidogenesis without improving insulin resistance. Despite GnRH analogue therapy, progressive ovarian enlargement in the presence of hyperinsulinemia from worsening metabolic function eventually required bilateral salpingo-oophorectomy for removal of massively enlarged ovaries. Histological examination showed both ovaries contained proliferating granulosa cells within antral follicles coexistent with serous cystadenofibromas.<br />Conclusions: In women with PCOS and hyperinsulinemia from severe insulin resistance due to metabolic syndrome, granulosa cell proliferation within antral follicles can occur despite long-term GnRH analogue therapy, implicating hyperinsulinemia as a granulosa cell mitogen in the absence of gonadotropin-dependent ovarian function.<br /> (Copyright © 2019 Endocrine Society.)
- Subjects :
- Abdominal Pain etiology
Adult
Cell Proliferation
Cystadenofibroma complications
Cystadenofibroma pathology
Cystadenofibroma surgery
Female
Humans
Hyperandrogenism complications
Hyperandrogenism metabolism
Hyperinsulinism complications
Insulin Resistance
Organ Size
Ovarian Neoplasms complications
Ovarian Neoplasms pathology
Ovarian Neoplasms surgery
Polycystic Ovary Syndrome complications
Polycystic Ovary Syndrome metabolism
Polycystic Ovary Syndrome surgery
Salpingo-oophorectomy
Severity of Illness Index
Tomography, X-Ray Computed
Ultrasonography
Fertility Agents, Female therapeutic use
Granulosa Cells pathology
Hyperandrogenism drug therapy
Hyperinsulinism metabolism
Leuprolide therapeutic use
Ovarian Follicle pathology
Polycystic Ovary Syndrome drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1945-7197
- Volume :
- 104
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- The Journal of clinical endocrinology and metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 30759233
- Full Text :
- https://doi.org/10.1210/jc.2018-02464