Functioning gonadotroph adenoma with hyperestrogenemia and ovarian hyperstimulation in a reproductive-aged woman:A case report and review of literature

BACKGROUND Functioning gonadotroph adenomas are extremely rare pituitary tumors that secrete gonadotropins and exhibit distinct clinical manifestations.Here,we report a case of functioning gonadotroph adenoma in a reproductive-aged woman and discuss its diagnosis and management.CASE SUMMARY A 21-year-old female patient with abdominal pain,irregular menstruation,hyperestrogenemia,and an ovarian mass was included.Brain magnetic resonance imaging(MRI)revealed a pituitary macroadenoma,and transsphenoidal surgery relieved her clinical symptoms.Before transsphenoidal surgery,plasma CA125,estradiol levels were elevated,while prolactin,luteinizing hormone,follicle-stimulating hormone,PROG,cortisol,FT4,thyroid-stimulating hormone,para-thyroid hormone,and GH levels were maintained at normal levels.After trans-sphenoidal surgery,the patient was diagnosed with a functioning gonadotroph adenoma.During follow-up,pelvic ultrasound confirmed normal-sized ovaries in the patient,the menstrual cycle returned to regular,and her hormones were maintained within a normal range.There was no evidence of tumor recurrence after two years of follow-up.CONCLUSION Early diagnosis of functioning gonadotroph adenomas should be considered in patients with hyperestrogenism,irregular menstruation,large or recurrent ovarian cysts,and visual field defects.Pituitary MRI should be performed,and transsphenoidal surgery is recommended for the management of this disease.

Functioning Gonadotroph Adenoma with Secondary Hypersecretion of Testosterone

Introduction: Gonadotroph adenomas are generally nonfunctioning. Hypersecretion of gonadotropins by gonadotroph adenomas rarely induced hypersecretion of testosterone. We report a case of functioning gonadotroph adenoma with secondary hypersecretion of testosterone. Medical Observation: A 25-year-old patient who having had a progressive and bilateral loss of visual acuity for two years. The ophtalmologist’s examination concluded to bitemporal hemianopia. He had no other clinical manifestations of hyper or hypo hormonal secretion. The brain scan has revealed an intrasellar mass with suprasellar development that represses the optic chiasma and the carotids. The assessment carried out revealed an increase in FSH, LH and testosterone. The diagnosis of a functioning gonadotroph macroadenoma with secondary hypersecretion of testosterone was retained. Surgical excision of the adenoma was performed. Anatomo-pathological examination concluded to a pituitary adenoma. The patient showed an improvement in the right visual acuity and developed an adrenal corticotropic insufficiency substituted by hydrocortisone 20 mg per day. The postoperative hormonal profile revealed a normalization of FSH and testosterone. Conclusion: Functioning gonadotroph adenoma with secondary hypersecretion of testosterone is rare. The first-line treatment is surgical and allows an improvement of the cerebral tumor syndrome and the restoration of the gonadotropic function.

Functioning gonadotroph adenoma

To the Editor:Pituitary gonadotroph adenoma is a type of non-functioning pituitary adenoma of which approximately 35%ecrete biologically active luteinizing hormone(LH)or follicle-stimulating hormone(FSH),and these adenomas are named functioning gonadotroph adenoma(FGA).We present three cases of FSH-secreting adenomas who were admitted to our hospital between 2014 and 2016.Case 1:A 37-year-old woman was admitted due to menstrual irregularity and galactorrhea for 2 years.The laboratory tests showed a significantly elevated estradiol 2(E2)level,and multiple cyst fusions could be observed by transvaginal ultrasonography.The pituitary magnetic resonance imaging(MRI)revealed an upper-right wing distension and detected a mass with a size of approximately 7.5 mm×10.7 mm in the saddle area,and a pituitarymacroadenoma was considered.The patient underwent a transsphenoidal microsurgical resection of the pituitary adenoma.The pathologic examination showed a positive result for FSH,LH,and SF-1,and a negative result for growth hormone,insulin-like growth factor 1,TPIT,and PIT1.