SECONDARY AMENORRHEA AND LH HYPERSECRETION - AN UNUSUAL PRESENTATION OF A GRANULOSA-CELL OVARIAN TUMOR

Granulosa cell ovarian tumors are infrequent. Since they originate fro m the gonadal stroma, they retain a high secretory potential and some of their clinical manifestations may be secondary to the production of sexual steroids. A 36 years old woman with an ovarian tumor presentin g as a secondary amenorrhea is reported. This patient had a positive p rogesterone test and her hormonal profile showed a maintained LH hyper secretion (> 75 mUl/ml) which, joined to the presence of a hypophyseal microadenoma lead to suspect the presence of a gonadotrophin secretin g tumor. The absence of LH response to TRH and its adequate suppressio n using oral contraceptives discarded this diagnosis. The histopatholo gy of the excised ovarian tumor demonstrated that it is was a granulos a cell tumor. The physiopathological explanation of the case is based on the maintained levels of estrogens produced by the tumor that, thro ugh a positive feed-back mechanism similar to that of the polycystic o vary syndrome, produced a tonic LH elevation and GnRH hyper response, After the tumor excision, ovulatory cycles resumed and the patient bec ame pregnant, facts that confirm the postulated hypothesis.