Inhibin as a Marker for Granulosa-Cell Tumors

• Published in: The New England journal of medicine Vol. 321; no. 12; pp. 790 - 793
• Main Authors: Lappöhn, Richard E, Burger, Henry G, Bouma, Joke, Bangah, Mohan, Krans, Mindert, De Bruijn, Henk W.A
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 21.09.1989
• Subjects: Adult; Amenorrhea - blood; Amenorrhea - etiology; Biological and medical sciences; Biomarkers - blood; Female; Female genital diseases; Fertility; Granulosa Cell Tumor - blood; Granulosa Cell Tumor - complications; Granulosa Cell Tumor - diagnosis; Gynecology. Andrology. Obstetrics; Humans; Infertility, Female - blood; Infertility, Female - etiology; Inhibins - blood; Medical sciences; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Ovarian cancer; Ovarian Neoplasms - blood; Ovarian Neoplasms - complications; Ovarian Neoplasms - diagnosis; Tumors; Endocrinopathy; Human; Peptide hormone; Inhibin; Tumoral marker; Malignant tumor; Female genital diseases; Screening; Ovarian diseases; Ovary; Radioimmunoassay; Tumor; Hormonal investigation; Granulosa
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198909213211204

Inhibin is a peptide hormone normally produced by ovarian granulosa cells. It reaches a peak of 772±38 U per liter in the follicular phase of the menstrual cycle and is undetectable in the serum of menopausal women. To determine whether measurements of serum inhibin levels would provide a biochemical marker of the presence or progression of ovarian granulosa-cell tumors and their metastases, we measured the serum immunoreactive inhibin concentrations in six women with such tumors. Three women had been treated by hysterectomy and bilateral salpingo-oophorectomy. In the two women with residual or recurrent disease, the serum inhibin levels were abnormally elevated 5 and 20 months before the clinical manifestations of recurrence became evident. The maximal concentrations approached 3000 U per liter. The serum inhibin level remained undetectable in one patient who was disease-free for 11 years. Serum inhibin concentrations were also elevated in three women with amenorrhea and infertility that resulted from small granulosa-cell tumors. After the removal of the tumors, the serum inhibin levels in these women became normal, and fertility returned. There was a significant negative correlation between the serum concentrations of inhibin and follicle-stimulating hormone, in a manner consistent with the autonomous production of inhibin by granulosa-cell tumors. We conclude that granulosa-cell tumors produce inhibin. Since serum inhibin levels reflect the size of the tumor, measurements of inhibin can be used as a marker for primary as well as recurrent disease. (N Engl J Med 1989; 321:790–3.) GRANULOSA-CELL tumors originate in the specialized ovarian stroma. Although stromal tumors constitute only 8 percent of all ovarian tumors (benign and malignant) and only 15 percent of these are granulosa-cell tumors, the latter are of considerable clinical importance, because they account for 5 to 10 percent of cases of ovarian cancer. The peak incidence of granulosa-cell tumors occurs among persons in the fifth or sixth decades, but the tumors are found among all age groups and can cause precocious puberty, amenorrhea and infertility, or metrorrhagia. Although these tumors are usually not highly aggressive, the poor prognostic factors include age of . . .