FUNCTIONAL GONADOTROPH PITUITARY ADENOMA PRESENTING WITH BITEMPORAL HEMIANOPIA
AACE ePoster Library. O'Malley G. 05/13/15; 97778; 808
Grenye O'Malley
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Abstract
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Objective: To present a case of a male patient who presented with bitemporal hemianopia and was found to have a functional pituitary gonadotroph macroadenoma secreting both FSH and LH with preserved testosterone, all three of which decreased dramatically post-resection.
Case Presentation: A 55-year-old man presented with bilateral peripheral vision loss and was found to have bitemporal hemianopia. He reported intermittent headaches and denied changes in weight, changes in hand or foot size, fatigue, easy bruising, thinning of skin, muscle weakness or decreased libido. Physical exam was otherwise unremarkable. An MRI revealed a 3.5x3.7x5.2cm well-circumscribed mass in the sella and suprasellar region with mass effect on the optic chiasm. Initial labs included prolactin 31.2ng/ml, IGF-1 126ng/mL, GH <0.1ng/mL, ACTH 23.5pg/mL, cortisol 3.9ug/dL, TSH 0.47uIU/mL, free thyroxine 0.83ng/dL, FSH 25.8mIU/ml, LH 7.2mIU/mL and testosterone 792ng/dL. Levothyroxine and twice daily hydrocortisone were started, and the patient was referred for transsphenoidal resection. Post-operative labs were unchanged except for FSH, LH and testosterone which drastically decreased to 1.4mIU/ml, 0.2mIU/mL and less then 2.5ng/dL, respectively. Repeat MRI showed a small amount of residual pituitary tissue with minimal distortion of the optic chiasm. Pathology staining showed pituitary adenomatous cells positive for FSH and LH.
Discussion: Gonadotroph adenomas represent about 35% of pituitary adenomas and are the most common type of nonfunctioning macroadenomas. The majority of gonadotroph adenomas are nonsecretory, and those that are secretory are associated with hypogonadism, which is thought to be secondary to a combination of hyperprolactinemia, mass effect on normal gonadotroph function and production of a non-functional gonadotroph. There are only a handful of published case reports of functional gonadotroph adenomas secreting FSH and LH resulting in preserved testosterone secretion. Like our patient, most presented with vision defects with one young boy presenting with precocious puberty. Only one other case report published by Dizon et al reported post-operative testosterone levels similar to our patient.
Case Presentation: A 55-year-old man presented with bilateral peripheral vision loss and was found to have bitemporal hemianopia. He reported intermittent headaches and denied changes in weight, changes in hand or foot size, fatigue, easy bruising, thinning of skin, muscle weakness or decreased libido. Physical exam was otherwise unremarkable. An MRI revealed a 3.5x3.7x5.2cm well-circumscribed mass in the sella and suprasellar region with mass effect on the optic chiasm. Initial labs included prolactin 31.2ng/ml, IGF-1 126ng/mL, GH <0.1ng/mL, ACTH 23.5pg/mL, cortisol 3.9ug/dL, TSH 0.47uIU/mL, free thyroxine 0.83ng/dL, FSH 25.8mIU/ml, LH 7.2mIU/mL and testosterone 792ng/dL. Levothyroxine and twice daily hydrocortisone were started, and the patient was referred for transsphenoidal resection. Post-operative labs were unchanged except for FSH, LH and testosterone which drastically decreased to 1.4mIU/ml, 0.2mIU/mL and less then 2.5ng/dL, respectively. Repeat MRI showed a small amount of residual pituitary tissue with minimal distortion of the optic chiasm. Pathology staining showed pituitary adenomatous cells positive for FSH and LH.
Discussion: Gonadotroph adenomas represent about 35% of pituitary adenomas and are the most common type of nonfunctioning macroadenomas. The majority of gonadotroph adenomas are nonsecretory, and those that are secretory are associated with hypogonadism, which is thought to be secondary to a combination of hyperprolactinemia, mass effect on normal gonadotroph function and production of a non-functional gonadotroph. There are only a handful of published case reports of functional gonadotroph adenomas secreting FSH and LH resulting in preserved testosterone secretion. Like our patient, most presented with vision defects with one young boy presenting with precocious puberty. Only one other case report published by Dizon et al reported post-operative testosterone levels similar to our patient.
Objective: To present a case of a male patient who presented with bitemporal hemianopia and was found to have a functional pituitary gonadotroph macroadenoma secreting both FSH and LH with preserved testosterone, all three of which decreased dramatically post-resection.
Case Presentation: A 55-year-old man presented with bilateral peripheral vision loss and was found to have bitemporal hemianopia. He reported intermittent headaches and denied changes in weight, changes in hand or foot size, fatigue, easy bruising, thinning of skin, muscle weakness or decreased libido. Physical exam was otherwise unremarkable. An MRI revealed a 3.5x3.7x5.2cm well-circumscribed mass in the sella and suprasellar region with mass effect on the optic chiasm. Initial labs included prolactin 31.2ng/ml, IGF-1 126ng/mL, GH <0.1ng/mL, ACTH 23.5pg/mL, cortisol 3.9ug/dL, TSH 0.47uIU/mL, free thyroxine 0.83ng/dL, FSH 25.8mIU/ml, LH 7.2mIU/mL and testosterone 792ng/dL. Levothyroxine and twice daily hydrocortisone were started, and the patient was referred for transsphenoidal resection. Post-operative labs were unchanged except for FSH, LH and testosterone which drastically decreased to 1.4mIU/ml, 0.2mIU/mL and less then 2.5ng/dL, respectively. Repeat MRI showed a small amount of residual pituitary tissue with minimal distortion of the optic chiasm. Pathology staining showed pituitary adenomatous cells positive for FSH and LH.
Discussion: Gonadotroph adenomas represent about 35% of pituitary adenomas and are the most common type of nonfunctioning macroadenomas. The majority of gonadotroph adenomas are nonsecretory, and those that are secretory are associated with hypogonadism, which is thought to be secondary to a combination of hyperprolactinemia, mass effect on normal gonadotroph function and production of a non-functional gonadotroph. There are only a handful of published case reports of functional gonadotroph adenomas secreting FSH and LH resulting in preserved testosterone secretion. Like our patient, most presented with vision defects with one young boy presenting with precocious puberty. Only one other case report published by Dizon et al reported post-operative testosterone levels similar to our patient.
Case Presentation: A 55-year-old man presented with bilateral peripheral vision loss and was found to have bitemporal hemianopia. He reported intermittent headaches and denied changes in weight, changes in hand or foot size, fatigue, easy bruising, thinning of skin, muscle weakness or decreased libido. Physical exam was otherwise unremarkable. An MRI revealed a 3.5x3.7x5.2cm well-circumscribed mass in the sella and suprasellar region with mass effect on the optic chiasm. Initial labs included prolactin 31.2ng/ml, IGF-1 126ng/mL, GH <0.1ng/mL, ACTH 23.5pg/mL, cortisol 3.9ug/dL, TSH 0.47uIU/mL, free thyroxine 0.83ng/dL, FSH 25.8mIU/ml, LH 7.2mIU/mL and testosterone 792ng/dL. Levothyroxine and twice daily hydrocortisone were started, and the patient was referred for transsphenoidal resection. Post-operative labs were unchanged except for FSH, LH and testosterone which drastically decreased to 1.4mIU/ml, 0.2mIU/mL and less then 2.5ng/dL, respectively. Repeat MRI showed a small amount of residual pituitary tissue with minimal distortion of the optic chiasm. Pathology staining showed pituitary adenomatous cells positive for FSH and LH.
Discussion: Gonadotroph adenomas represent about 35% of pituitary adenomas and are the most common type of nonfunctioning macroadenomas. The majority of gonadotroph adenomas are nonsecretory, and those that are secretory are associated with hypogonadism, which is thought to be secondary to a combination of hyperprolactinemia, mass effect on normal gonadotroph function and production of a non-functional gonadotroph. There are only a handful of published case reports of functional gonadotroph adenomas secreting FSH and LH resulting in preserved testosterone secretion. Like our patient, most presented with vision defects with one young boy presenting with precocious puberty. Only one other case report published by Dizon et al reported post-operative testosterone levels similar to our patient.
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