PMID- 30759233
OWN - NLM
STAT- Publisher
LR  - 20190213
IS  - 1945-7197 (Electronic)
IS  - 0021-972X (Linking)
DP  - 2019 Feb 12
TI  - Massive Ovarian Growth in a Severe Insulin-Resistant Polycystic Ovary Syndrome
      (PCOS) Woman Receiving GnRH-Analog.
LID - 10.1210/jc.2018-02464 [doi]
AB  - Context: Ovarian hyperandrogenism from polycystic ovarian syndrome (PCOS) and
      hyperinsulinemia from insulin resistance are modulators of ovarian follicle
      development. We report a PCOS woman with hyperandrogenism and severe insulin
      resistance from metabolic syndrome who received long-term GnRH analog therapy
      preceding bilateral salpingo-oophorectomy for massive ovarian enlargement.
      Ovarian histological examination showed proliferating granulosa cells within
      antral follicles coexistent with serous cystadenofibromas, demonstrating a unique
      link between hyperinsulinemia and granulosa cell mitogenesis. Case Description: A
      30-year-old PCOS woman with hyperandrogenism and severe insulin resistance from
      metabolic syndrome and nonalcoholic steatohepatitis (NASH) experienced abdominal 
      pain from bilaterally enlarged ovaries. She had previously experienced a
      pulmonary embolism while on oral contraceptives and hepatotoxicity from metformin
      and spironolactone therapies. Long-term GnRH analog therapy to induce pituitary
      desensitization to GnRH successfully decreased gonadotropin-dependent
      steroidogenesis without improving insulin resistance. Despite GnRH analog
      therapy, progressive ovarian enlargement in the presence of hyperinsulinemia from
      worsening metabolic function eventually required bilateral salpingo-oophorectomy 
      for removal of massively enlarged ovaries. Histological examination showed both
      ovaries to contain proliferating granulosa cells within antral follicles
      coexistent with serous cystadenofibromas. Conclusions: In a PCOS woman with
      hyperinsulinemia from severe insulin resistance due to metabolic syndrome,
      granulosa cell proliferation within antral follicles can occur despite long-term 
      GnRH analog therapy, implicating hyperinsulinemia as a granulosa cell mitogen in 
      the absence of gonadotropin-dependent ovarian function.
FAU - Singh, Prapti
AU  - Singh P
AD  - Department of Obstetrics and Gynecology, University of Texas Medical Branch,
      Galveston, Texas.
FAU - Agress, Ariela
AU  - Agress A
AD  - Department of Obstetrics and Gynecology, David Geffen School of Medicine,
      University of California Los Angeles (UCLA), Los Angeles, CA.
FAU - Madrigal, Vanessa
AU  - Madrigal V
AD  - Department of Obstetrics and Gynecology, David Geffen School of Medicine,
      University of California Los Angeles (UCLA), Los Angeles, CA.
FAU - Magyar, Clara
AU  - Magyar C
AD  - Department of Pathology and Laboratory Medicine, David Geffen School of Medicine,
      University of California Los Angeles (UCLA), Los Angeles, CA.
FAU - Ostrzega, Nora
AU  - Ostrzega N
AD  - Department of Pathology and Laboratory Medicine, David Geffen School of Medicine,
      University of California Los Angeles (UCLA), Los Angeles, CA.
FAU - Chazenbalk, Gregorio Daniel
AU  - Chazenbalk GD
AD  - Department of Obstetrics and Gynecology, David Geffen School of Medicine,
      University of California Los Angeles (UCLA), Los Angeles, CA.
FAU - Dumesic, Daniel Anthony
AU  - Dumesic DA
AD  - Department of Obstetrics and Gynecology, David Geffen School of Medicine,
      University of California Los Angeles (UCLA), Los Angeles, CA.
LA  - eng
PT  - Journal Article
DEP - 20190212
PL  - United States
TA  - J Clin Endocrinol Metab
JT  - The Journal of clinical endocrinology and metabolism
JID - 0375362
EDAT- 2019/02/14 06:00
MHDA- 2019/02/14 06:00
CRDT- 2019/02/14 06:00
PHST- 2018/11/14 00:00 [received]
PHST- 2019/02/07 00:00 [accepted]
PHST- 2019/02/14 06:00 [entrez]
PHST- 2019/02/14 06:00 [pubmed]
PHST- 2019/02/14 06:00 [medline]
AID - 5315431 [pii]
AID - 10.1210/jc.2018-02464 [doi]
PST - aheadofprint
SO  - J Clin Endocrinol Metab. 2019 Feb 12. pii: 5315431. doi: 10.1210/jc.2018-02464.