Taiwanese Journal of Obstetrics and Gynecology
Volume 48, Issue 1 , Pages 72-75, March 2009

Secondary Amenorrhea with Low Serum Luteinizing Hormone and Follicle-stimulating Hormone Caused by an Inhibin A- and Inhibin B-producing Granulosa Cell Tumor

  • Marzieh Agha-Hosseini

      Affiliations

    • Infertility Center of Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
    • ,
  • Ashraf Aleyaseen

      Affiliations

    • Infertility Center of Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
    • ,
  • Leili Safdarian

      Affiliations

    • Infertility Center of Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
    • ,
  • Ladan Kashani

      Affiliations

    • Infertility Center of Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
    • Infertility Ward, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
    • Corresponding Author InformationCorrespondence to: Dr Ladan Kashani, Infertility Ward, Arash Hospital, Tehean Pars Street, Rashid Street, Tehran University of Medical Sciences, Tehran, Iran

Accepted 30 April 2008.

Article Outline

Summary 

Objective

Here, we report a case of secondary amenorrhea with low serum luteinizing hormone and follicle-stimulating hormone levels due to an inhibin A- and inhibin B-producing granulosa cell tumor of the ovary.

Case Report

A woman aged 26 with infertility, secondary amenorrhea and low levels of gonadotropin was referred to us as a case of hypothalamic amenorrhea. There was a mass measuring 56 × 41mm in her right adnexa. We were suspicious of malignancy and checked the tumor marker levels. Laboratory findings showed high levels of inhibin A and B. She underwent an exploratory laparotomy. Microscopic examination revealed an adult granulosa cell tumor. Eighteen days after excision, she had spontaneous menstruation with normal levels of follicle-stimulating hormone and luteinizing hormone.

Conclusion

A granulosa cell tumor secretes inhibin A and B, which suppress follicle-stimulating hormone and luteinizing hormone release through a central mechanism. This leads to amenorrhea, which can be misdiag-nosed as hypothalamic amenorrhea. Inhibin-producing ovarian tumors must be considered in the assessment of patients with apparent hypothalamic amenorrhea.

Key Words:  follicle-stimulating hormone , granulosa cell tumor , inhibin A , inhibin B , luteinizing hormone

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References 

  1. Marshall JC , Eagleson CA , McCartney CR . Hypothalamic dysfunction . Mol Cell Endocrinol . 2001;183:29–32
  2. Mom CH, Engelen MJ, Willemse PH, Gietema JA, ten Hoor KA, de Vries EG, et al. Granulosa cell tumors of the ovary: the clinical value of serum inhibin A and B levels in a large single center cohort . Gynecol Oncol . 2007;105:365–372
  3. Petraglia F , Hartmann B , Luisi S , et al.   Low levels of serum inhibin A and inhibin B in women with hypergonadotropic amenorrhea and evidence of high levels of activin A in women with hypothalamic amenorrhea . Fertil Steril . 1998;70:907–912
  4. Unkila-Kallio L , Tiitinen A , Wahlström T , Lehtovirta P , Leminen A . Reproductive features in women developing ovarian granulosa cell tumour at a fertile age . Hum Reprod . 2000;15:589–593
  5. Lappohn RE , Burger HG , Bouma J , Bangah M , Krans M , de Bruijn HW . Inhibin as a marker for granulosa-cell tumors . N Engl J Med . 1989;321:790–793
  6. Petraglia F, Luisi S, Pautier P, Sabourin JC, Rey R, Lhomme C, et al. Inhibin B is the major form of inhibin/activin family secreted by granulosa cell tumors . J Clin Endocrinol Metab . 1998;83:1029–1032
  7. Groome NP, Illingworth PJ, O'Brien M, Pai R, Rodger FE, Mather JP, et al. Measurement of dimeric inhibin B throughout the human menstrual cycle . J Clin Endocrinol Metab . 1996;81:1401–1405
  8. Practice Committee of the American Society for Reproductive Medicine  . Current evaluation of amenorrhea . Fertil Steril . 2006;86(Suppl):S148–S155
  9. Farnworth PG , Robertson DM , de Kretser DM , Burger HG . Effects of 31 kDa bovine inhibin on FSH and LH in rat pituitary cells in vitro: antagonism of gonadotrophin-releasing hormone agonists . J Endocrinol . 1988;119:233–241
  10. Messinis IE . Ovarian feedback, mechanism of action and possible clinical implications . Hum Reprod Update . 2006;12:557–571
  11. Kurihara S , Hirakawa T , Amada S , Ariyoshi K , Nakano H . Inhibin-producing ovarian granulosa cell tumor as a cause of secondary amenorrhea: case report and review of the literature . J Obstet Gynaecol Res . 2004;30:439–443
  12. Crew KD , Cohen MH , Smith DH , Tiersten AD , Feirt NM , Hershman DL . Long natural history of recurrent granulosa cell tumor of the ovary 23 years after initial diagnosis: a case report and review of the literature . Gynecol Oncol . 2005;96:235–240
  13. Krishnan A, Murdock C, Allard J, Cisar M, Reid E, Nieman L, et al. Pseudo-isolated FSH deficiency caused by an inhibin B-secreting granulosa cell tumour: case report . Hum Reprod . 2003;18:502–505
  14. Burger HG , Fuller PJ , Chu S , et al.   The inhibins and ovarian cancer . Mol Cell Endocrinol . 2001;180:145–148
  15. Hildebrandt RH , Rouse RV , Longacre TA . Value of inhibin in the identification of granulosa cell tumors of the ovary . Hum Pathol . 1997;28:1387–1395

PII: S1028-4559(09)60040-1

doi:10.1016/S1028-4559(09)60040-1

Taiwanese Journal of Obstetrics and Gynecology
Volume 48, Issue 1 , Pages 72-75, March 2009

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