A case series on secondary amenorrhea due to Pituitary Adenomas and its management

DR. NIMRATA PAUL; DR. JAMEELA C.; DR. JOYLENE D‘ ALMEIDA

Volume : VII, Issue : I, January - 2018

A case series on secondary amenorrhea due to Pituitary Adenomas and its management

Dr. Nimrata Paul, Dr. Jameela C. , Dr. Joylene D 8216 Almeida

Abstract :

INTRODUCTION: There are many potential causes of pituitary–associated amenorrhea. Pituitary causes of amenorrhea constitute 18% of cases of secondary amenorrhea and 7% of cases of primary amenorrhea.

BACKGROUND:

CASE 1: 28 years old nulligravid female came with secondary amenorrhea, galactorrhea, headache and disturbed vision with acromegaloid facies. Hormonal Workup revealed prolactin level of 65 ng/ml and MRI ain shows 1.9 x 1.1 x1.9 cm lesion in the sellar and suprasellar area.

CASE 2: 22 years old nulligravid female presented with secondary amenorrhea with h/o generalized weakness, headache, and diabetes mellitus, with acromegaloid facies. Work up reveals normal serum prolactin (14 ng/ ml), MRI ain revealed 2.4 x 2 x 2.3 cm lesion causing widening of sella, extending into suprasellar region with extension into ICA.

CASE 3: 27 years old nulligravid female presented with irregular menstrual cycles, galactorrhea with headache and diplopia. Work up reveals prolactin level of 157 ng/ml and MRI ain showed 6x4 mm lesion in the right half of pituitary gland with pituitary stalk displaced to the left.

CASE 4: 28 year old woman, gym trainer, oligomenorrheic until the age of 18 years, when she was started on oral contraceptives. At the age of 28 years, she stopped the OCPs in order to attempt to become pregnant.3 months after discontinuing the OCPs, she remained amenorrheic. Work–up revealed prolactin 45 ng/ml, low–normal FSH and LH, low estradiol level of 30 pg/ml. Pituitary–protocol MRI demonstrated a 3mm hypodense lesion on the right side of the pituitary gland, consistent with a pituitary adenoma.

CASE 5: 24 years old nulligravid female presented with h/o oligomenorrhea since 5 years. Work up reveals serum prolactin 120 ng/ml, normal LH, FSH. MRI ain revealed 5mm area of persistent delayed enhancement right side of the pituitary gland, suggestive of microadenoma.

CASE 6: 35 years old female presented with secondary infertility with h/o oligomenorrhea since 5 years. Work up reveals serum prolactin 150 ng/ml, low normal LH, FSH. MRI ain revealed 8mm lesion in the right side of the pituitary gland, consistent with microadenoma.

MATERIAL AND METHODS: Patients who presented with secondary amenorrhea and diagnosed with pituitary adenomas, at FMMCH, Mangalore, and treated for the same as either outpatients or inpatients.

RESULTS: Based on clinical examination, lab reports and MRI findings, diagnosis of growth hormone secreting pituitary macroadenoma was made for CASE 1 AND 2, and non functional pituitary microadenomas was made for CASE 3,4,5,6. One of the Macroadenomas was successfully operated and symptoms subsided, whereas other one was lost to follow up. All microadenomas were successfully managed medically, with return of menstrual cycles with anti–prolactin therapy.

CONCLUSION:

Pituitary causes of amenorrhea should be considered in women with low or normal gonadotrophin levels. Therapy for pituitary adenomas depends on the specific type of tumour, and should be managed with a team approach to include endocrinology and neurosurgery when indicated.