Gonadotroph adenomas represent 4050% of pituitary macroadenomas. Only a small subset of these tumors secrete sufficient hormone to elevate serum gonadotropin levels (functioning gonadotroph tumors).
We are presenting the case of a 30-year-old male patient (E.R) having a characteristic symptomatology for the pituitary macroadenoma: headaches, impaired visual acuity and reduced visual field (based on ophthalmological examination). MRI (with gadolinium-based contrast agent) showed an intrasellar mass with sphenoidal, nasal and suprasellar extension, measuring 4×5 cm. Transfrontal pituitary adenomectomy was performed. Postoperative CT scan showed no remnant tumor. The patient had a favorable clinical evolution, headaches and visual symptoms improving after surgery. Postoperatory, the patient presented polyuropolydipsic syndrome. Endocrine studies were performed only after surgery. The clinical examination indicated normal secondary sexual characters, normal testes shape and consistency, with a testes volume over the maximum Prader level. Postoperative hormonal assays indicated: secondary hipoadrenalism, central hypothyroidism, normal PRL serum level, low testosterone, LH and GH serum levels and very high FSH serum level. The substitutive hormonal therapy was initiated with: cortisol, antidiuretic hormone and thyroid hormones. One month postoperatory, the patient was asymptomatic, without additional visual impairment. The hormonal assays indicated persistent high FSH serum level, normal thyroid hormones, testosterone, LH and PRL levels, with low cortisol serum level. The therapy was supplemented with Bromocriptine (10 mg daily) and with undecanoate testosterone (80 mg daily p.o.). Three months postoperatory, the FSH serum level was persistently high and PRL level was under the normal values. LH and thyroid hormones serum levels were normal and testosterone level was over the normal values.
The persistent postoperatory high FSH serum levels are suggestive for an FSH secreting pituitary adenoma. The treatment management has to be reevaluated depending on the clinical and paraclinical evolution.