OBJECTIVE: To report a case of a gonadotroph adenoma diagnosed after a dramatic 
increase in estradiol level and ovarian hyperstimulation in response to a 
gonadotropin-releasing hormone agonist.
DESIGN: Case report.
SETTING: Outpatient practice and university hospital.
PATIENT(S): A 35-year-old woman who presented with infertility, amenorrhea, and 
an elevated basal estradiol concentration.
INTERVENTION(S): Ultrasonography, laparoscopy, endocrinologic assays, magnetic 
resonance imaging, transsphenoidal surgery, and immunocytochemical staining.
MAIN OUTCOME MEASURE(S): Ultrasonography and laparoscopy demonstrated 
bilaterally enlarged ovaries containing multiple preovulatory follicles, similar 
in appearance in those women undergoing controlled ovarian hyperstimulation with 
exogenous FSH. The serum estradiol level was moderately elevated, the FSH level 
was within the normal range, and LH was suppressed. Administration of leuprolide 
acetate resulted in very elevated estradiol concentrations and even larger 
ovarian cysts. Magnetic resonance imaging demonstrated a sellar mass. 
Examination of the tissue excised by transsphenoidal excision of the mass showed 
a pituitary adenoma that stained strongly for FSH.
RESULT(S): Regular menses resumed soon after excision of the gonadotroph 
adenoma, followed by a spontaneous pregnancy.
CONCLUSIONS: Gonadotroph adenoma should be suspected in a reproductive age woman 
with oligomenorrhea or amenorrhea, infertility, multiple preovulatory follicles, 
and a persistently elevated serum estradiol concentration. Exacerbation of the 
ovarian hyperstimulation in response to a gonadotropin-releasing hormone agonist 
in this setting also strongly suggests a gonadotroph adenoma but can be avoided 
by recognizing the presenting features of this condition.