Ultrasound examination revealed multiple two to three centimeter ovariancysts and a bilateral ovarian diameter of approximately 20 cm. A laparot-omy was performed and multiple benign follicular cysts excised. Laboratoryevaluation showed an FSH of 6.8 mIU/ml, LH of 0.1 mIU/ml, prolactin of67 ng/ml, progesterone of 3.5 ng/ml, estradiol of 237 pg/mL, and an�-subunit of 1.2 ng/ml. MRI examination of the sella demonstrated ahomogeneously enhancing mass measuring 2.0x2.3x1.5 cm within the pi-tuitary, which extended superiorly and impinged on the optic chiasm. Slightdeviation of the left internal carotid artery was noted and possible extensionto the left cavernous sinus.

Results: An uncomplicated transsphenoidal resection of all evident tumorwas performed, including a portion of tumor extending into the cavernoussinus. Pathologic description was consistent with a benign pituitary gona-dotroph adenoma. Sections revealed sheets of reticulin-free adenomatoustissue, comprised of cells with cytoplasm immunoreacting focally withantibodies against FSH, but not with those against GH, PRL, ACTH, LH,TSH or �-subunit. MRI examination two months after surgery confirmedthe absence of tumor within suprasellar and sellar regions, but revealed asmall amount of tissue within the cavernous sinus consistent with residualtumor. Her menstrual cycle resumed within 4 months, with laboratoryevidence of ovulation.

Conclusions: This patient had a FSH level within normal limits, whichsuggests that the FSH isoform was either biologically more active, or notadequately detected by our assay. Her estradiol level and elevated FSH/LHratio was consistent with tonic FSH stimulation, and her clinical pictureclearly suggested that the pituitary mass was secreting gonadotropins. Thiscase is another example of the conditions’ unusual presentation, and thepotential for misdirected management. Our case also outlines the need toview the ovary as a part of the hypothalamic-pituitary-gonadol axis, and notas an organ in isolation.

P-460

Antimullerian Hormone (AMH), inhibin B, ovarian volume, and antralfollicle count as markers of ovarian damage in young women treatedfor cancer in childhood. Richard A. Anderson, Louise E. Bath, HamishWallace. MRC Human Reproductive Science Unit, Edinburgh, UnitedKingdom; Section of Child Life and Health, Univ of Edinburgh, Edinburgh,United Kingdom.

Objective: Young women treated for cancer in childhood may shownormal pubertal progression and ovulatory cycles, but it is uncertain howmuch the ovary has been affected by their previous treatment. We haveinvestigated whether these women have a reduced ovarian reserve.

Design: Open observational studyMaterials and Methods: We recruited (a) 10 patients aged 16-24 yr (mean

24), and 11 controls 17-29 yr (mean 23), who all had regular menstrualcycles and (b) 11 patients aged 17-29 (mean 20) and 11 controls aged 22-26(mean 23) taking the combined contraceptive pill (COC). Patients had beentreated for cancer aged 3-15 yr. Blood samples were taken on cycle day 3-5or during the third week of COC administration before and 24 hr afteradministration of 225IU rhFSH. Ovarian volume and antral follicle count(AFC) were determined at the same time.

Results: Early follicular FSH was significantly higher in patients withregular cycles than in controls, 7.5�1.4 vs 4.2�0.3 IU/L (p � 0.02). Bothbasal and stimulated inhibin A, B and estradiol were similar in the twogroups. AMH however was significantly lower in patients than controls,13.0�3.0 vs 21.0�3.4pmol/L, p�0.05. Ovarian volume was also reducedin patients (3.0�0.5 vs 5.0�0.8ml, P�0.05) but AFC was similar in the twogroups.

COC administration was associated with a significant reduction in ovar-ian volume in both patients (3.0�0.5 to 1.7�0.3 ml) and controls (5.0�0.8to 2.1�0.2), but the off-COC difference between groups was lost. AFC wasreduced in patients on COC (4.2�0.8 vs 8.4�1.4, P�0.01), however it wasnot significantly reduced in controls (7.2�0.8 vs 9.0�1.2). While inhibin Brose from undetectable in all controls after FSH administration, it remainedundetectable in 6/11 patients. AMH was also similar in patients and controlson COC (8.8�3.0 and 12.0�1.8 respectively).

Conclusion: The use of AMH and ovarian volume allows the demonstra-tion of reduced ovarian reserve in young women with regular menstrual

cycles after childhood cancer treatment and adds to measurement of earlyfollicular FSH. Basal and stimulated inhibin B concentrations were pre-served, as was AFC, thus it appears that these women maintain a near-normal population of growing follicles despite a depleted follicular reserve.COC administration results in a reduced ovarian volume and AMH innormal young women, and under these conditions these markers of theovarian reserve do not distinguish controls from women treated for cancerin childhood. However AFC and, in some women, stimulated inhibin B, arelow, suggesting a reduced pool of small growing follicles. These investi-gations allow the identification and management of follicular depletion inthese young women.

P-461

Impact of restricted carbohydrate intake on women with PolycysticOvarian Syndrome (PCOS). Barry A. Ripps, Donald W. Langley, KarenKennedy, Brijinder S. Minhas. Univ of Florida, Pensacola, FL; New LIFE,Pensacola, FL.

Objective: To assess impact of restricted carbohydrate intake on clinicaland biochemical aberrations of PCOS.

Design: Retrospective analysisMaterials and Methods: Data were collected from women with obesity-

associated PCOS defined as irregular menstrual bleeding, hirsutism orhyperandrogenemia and body mass index (BMI) � 27. Records werereviewed for 75 patients initially seen in 15 months beginning January 1,2001. Clinical findings of age, weight, BMI, blood pressure, detection ofhirsutism, menstrual frequency, dose resistance to clomiphene inductionwere recorded. Lab results were recorded for fasting insulin, glucose, andlipid profile, FSH, LH, total testosterone, DHEAS. Subjects were counseledregarding initiation of a strict, low carbohydrate (CHO) diet with vitaminsupplementation and recommended to increase energy expenditure throughregular exercise. Testing was repeated after �6 weeks of reported orattempted compliance. Data were compared by paired, 2-tail, Student’s t testwhere appropriate.

Results: After counseling, 38 women consented to intervention as di-rected. Mean baseline parameters for these participants were age � 30years, weight � 99.5 kg, BMI � 36.5 kg/m2. At screening, 8% of womenwere diabetic, 24% were insulin resistant defined as fasting glucose/insulin(G/I) ratio � 4.5. Fasting total cholesterol was elevated in 52.6% of subjectsand triglycerides were elevated in 53%. During observation, 84% of womenlost weight and paired analyses show a significant reduction in weight(p�0.001) and BMI (p�0.001). Lipid changes revealed a reduction infasting total cholesterol of 23 mg/dL (p�0.001) and triglyerides of 54mg/dL (p�0.001), correcting elevated levels of cholesterol and triglyceridesin 68% and 77% of women, respectively. With weight changes indexed tovariable length of follow up, women who lost � 0.1 kg/week had significantreduction in fasting insulin (p�0.04). Spontaneous regular menstruationreturned in 59% of subjects. Nine pregnancies occurred during follow up, 4spontaneous and 5 with clomiphene induction. Notably, 4 of these 5 werepreviously clomiphene resistant.

Conclusions: This retrospective study shows that dietary and behavioralintervention offers benefits to a majority of obese PCOS women and thusremains a first-line option for management. Lipid changes associated with a lowcarbohydrate diet seen in this study may further provide cardiovascular protec-tion. Of key importance is the apparent finding that surprisingly small changesin BMI or weight significantly improve PCOS manifestations, suggesting thatdietary effort and insulin reduction may be the mechanism of benefit.

P-462

Effects of metformin and compound cyproterone acetate on patientswith polycystic ovarian syndrome. Bilu Ye, Haiyan Yang, Junzhao Zhao,Jinju Lin, Wenqin Lin, Frank Yelian. Wenzhou Medical Coll, Wenzhou,China; Wayne State Univ, Detroit, MI.

Objective: To study the clinical and endocrinologic effects of Metforminand compound cyproterone acetate (CPA, Schering AG, Germany) onpatients with polycystic ovarian syndrome (PCOS).

Design: A prospect and randomized study

S272 Abstracts Vol. 80, Suppl. 3, September 2003