Abstract
Purpose
We report a very rare case showing menstrual restoration in severe pan-hypopituitarism many years after cranial irradiation for suprasellar germinoma.
Case
A 30-year-old, almost primarily amenorrheic woman with severe panhypopituitarism presented with cyclic genital bleeding for the previous five months. She had menstruated once, when she was 13 years old. When she was 14 years old, she was diagnosed with a suprasellar germinoma measuring 10 mm in diameter, which led to diabetes insipidus. Cranial irradiation with a total dose of 24 Gy and chemotherapy resulted in complete tumor remission. She developed severe hypopituitarism [luteinizing hormone (LH) = 0.4 mIU/mL, follicle-stimulating hormone (FSH) = 1.7 mIU/mL, and serum estradiol (E2) level < 10 pg/mL]. She had received multiple hormone replacement therapies for many years. When she was 29 years old, she expressed a desire to become pregnant. Serum gonadotropin and E2 levels increased (LH = 5.8 mIU/mL, FSH = 5.9 mIU/mL, and E2 = 58 pg/mL). She conceived with clomiphene therapy, and then delivered a healthy baby. Eight months after parturition, her basal body temperature and serum progesterone levels indicated recovery of ovulatory cycles. Ten months after parturition, she also spontaneously conceived.
Conclusion
Menstrual restoration is very rare in severe panhypopituitarism after cranial irradiation. A relatively low dose of irradiation and small tumor size may have contributed to the recovery of menstruation in our patient.
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Conflict of interest
Masanobu Ito, Ichiro Iwamoto, Hirofumi Hirano, and Tsutomu Douchi each declare that they have no conflict of interest.
Human rights and informed consent
All procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from the patient for inclusion in the study.
Animal studies
This case report does not contain any studies with animal subjects performed by any of the authors.
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Ito, M., Iwamoto, I., Hirano, H. et al. Menstrual restoration in severe panhypopituitarism many years after cranial irradiation for suprasellar germinoma. Reprod Med Biol 14, 131–134 (2015). https://doi.org/10.1007/s12522-014-0200-6
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DOI: https://doi.org/10.1007/s12522-014-0200-6