menotropins and Craniopharyngioma

The authors report a rare case of a patient with panhypopituitarism who became pregnant by gonadotropin therapy and gave birth to a healthy baby. A brain tumour and/or the surgical resection of a brain tumour occasionally results in pituitary dysfunction. An 18-year-old Japanese patient developed hypogonadotropic secondary amenorrhoea because of a craniopharyngioma, which was surgically removed. The patient came to us, and peripheral blood was collected every 15 minutes for four hours. The levels of luteinising hormone (LH) and follicle-stimulating hormone (FSH) were measured. Results showed that LH and FSH levels were very low and did not fluctuate. Several years later, the patient complained of infertility, and treatment with human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) was started. The therapy was repeated for several cycles, but she did not conceive, so hMG-hCG therapy combined with conjugated oestrogen administration was started. The patient became pregnant at the seventh cycle of this combined therapy. She was not treated with supplementary growth hormone.

Topics: Adolescent; Adult; Chorionic Gonadotropin; Craniopharyngioma; Estrogens; Female; Fertility Agents, Female; Humans; Hypogonadism; Menotropins; Pituitary Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Outcome

Ovarian hyperstimulation syndrome (OHSS) is the most serious, life-threatening, iatrogenic complication of ovulation induction. The importance of excessive oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration as a predictor and factor in the pathophysiology of OHSS has been extensively studied and discussed. We present the case report of a woman with hypogonadotrophic hypogonadism who developed severe OHSS during ovulation induction with urinary human follicle stimulating hormone (FSH) and HCG in the presence of low circulating oestradiol concentrations. The implication of FSH treatment and complications in hypogonadotrophic hypogonadal patients, and the role of preovulatory oestradiol concentrations in the prediction of OHSS, are discussed.

Topics: Adult; Chorionic Gonadotropin; Craniopharyngioma; Estrogens; Female; Humans; Hypogonadism; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pituitary Neoplasms

A previously hypophysectomized man with azoospermia, who was on androgen replacement therapy since 11 years, was studied with regard to his intratesticular steroid conversion capacity in vitro after which he was given combined hCG/hMG therapy. Before therapy a steroid conversion pattern similar to that seen in prepubertal boys was found, i.e. a high proportion of 20 alpha-dihydroprogesterone was produced while only smaller amounts of 17 alpha-hydroxyprogesterone was produced from the substrate 3H-progesterone. After only five weeks of hCG/hMG treatment, sperm counts and serum testosterone levels increased dramatically and a child was conceived. The steroid conversion pattern simultaneously switched to the mature, adult type with a low production of 20 alpha-dihydroprogesterone and large amounts of 17 alpha-hydroxyprogesterone being produced in vitro. Thus gonadotrophin substitution therapy may still be very effective after long term androgen replacement.

Topics: Chorionic Gonadotropin; Combined Modality Therapy; Craniopharyngioma; Drug Therapy, Combination; Female; Humans; Infertility, Male; Long-Term Care; Male; Menotropins; Oligospermia; Pituitary Irradiation; Pituitary Neoplasms; Postoperative Complications; Seminiferous Epithelium; Sexual Maturation; Sperm Count; Sperm-Ovum Interactions; Spermatogenesis; Testis; Testosterone