Clinically functioning gonadotropin-secreting pituitary adenoma.

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM Endocrinology, Diabetes and Metabolism Case Reports Pub Date : 2024-03-20 Print Date: 2024-01-01 DOI:10.1530/EDM-22-0322
Noor Alnasrallah, Khaled Aljenaee, Maryam AlMurshed, Sulaiman Hajji
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Abstract

Summary: Gonadotroph adenomas are the most common type of nonfunctional pituitary adenomas. However, functioning gonadotroph adenomas causing clinical manifestations are rare. We present the case of a 42-year-old man with an incidental finding of a pituitary gland mass. A pituitary MRI revealed a 3 cm macroadenoma, and laboratory investigations revealed elevated follicle-stimulating hormone (FSH) and total testosterone levels. A diagnosis of functioning FSH-secreting pituitary adenoma was considered, with possible concomitant luteinizing hormone secretion, given the elevated testosterone, prompting further evaluation. Testicular ultrasound showed bilaterally enlarged testicles, and visual field testing revealed a monocular superior temporal defect. Transsphenoidal resection of pituitary adenoma was the treatment of choice. Histopathology assessment confirmed the diagnosis of gonadotroph-secreting adenoma, with positive staining for FSH. Within the 12-week postoperative period, FSH and testosterone levels normalized, and the patient experienced significant improvement in vision, along with the resolution of macroorchidism. While functional gonadotroph adenomas are rare, patients can present with a wide range of symptoms that are often unnoticeable due to their slow development. Careful evaluation can help guide multidisciplinary management to achieve full remission.

Learning points: Endocrine evaluation is indicated in all cases of pituitary incidentalomas to determine functional status. Clinically functioning gonadotroph adenomas, while rare, pose a diagnostic challenge and require careful clinical evaluation. Transsphenoidal surgery is the mainstay of treatment of functioning gonadotroph adenomas, with the involvement of a multidisciplinary team to achieve desirable outcomes.

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临床功能正常的促性腺激素分泌型垂体腺瘤。
摘要:促性腺激素腺瘤是最常见的非功能性垂体腺瘤。然而,引起临床表现的功能性促性腺激素腺瘤却很少见。我们介绍了一例偶然发现垂体肿块的 42 岁男性病例。垂体磁共振成像检查发现了一个 3 厘米大的腺瘤,实验室检查发现促卵泡激素(FSH)和总睾酮水平升高。考虑诊断为分泌 FSH 的功能性垂体腺瘤,鉴于睾酮升高,可能同时伴有促黄体生成素分泌,因此需要进一步评估。睾丸超声显示双侧睾丸增大,视野测试显示单眼颞上缺损。经蝶窦垂体腺瘤切除术是首选治疗方法。组织病理学评估确诊为分泌促性腺激素的腺瘤,FSH染色阳性。术后12周内,FSH和睾酮水平恢复正常,患者的视力明显改善,大睾丸症也得到了缓解。功能性促性腺激素腺瘤虽然罕见,但患者可表现出多种症状,由于其发展缓慢,往往不易察觉。仔细评估有助于指导多学科治疗,以实现完全缓解:内分泌评估适用于所有垂体偶发瘤病例,以确定功能状态。有临床功能的促性腺激素腺瘤虽然罕见,但对诊断提出了挑战,需要进行仔细的临床评估。经蝶窦手术是治疗功能性促性腺激素腺瘤的主要方法,需要多学科团队的参与才能取得理想的疗效。
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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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