Functional pituitary gonadotroph adenoma in male patients: a case study

Nanik Ram; Khan Sajjad Ali; Bhagwan Das; Najmul Islam

doi:10.1530/endoabs.73.EP156

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Endocrine Abstracts (2021) 73 EP156 | DOI: 10.1530/endoabs.73.EP156

ECE2021 Eposter Presentations Pituitary and Neuroendocrinology (32 abstracts)

Functional pituitary gonadotroph adenoma in male patients: a case study

Nanik Ram ¹ , Sajjad Ali Khan ¹ , Bhagwan Das ² & Najmul Islam ¹

Author affiliations

¹Aga Khan University Hospital, Department of Medicine, Section of Diabetes Mellitus, Metabolism and Endocrinology, Karachi, Pakistan; ²Cancer Foundation Hospital, Karachi, Pakistan

Background

Pituitary gonadotroph adenomas are common but very rarely do they secrete biologically active luteinizing hormone (LH) and follicle-stimulating hormone (FSH). There have been case studies reporting high sex hormones (testosterone/estrogen) in the presence of high or normal LH and FSH.

Case presentation

Here we report two cases who presented with visual disturbance and headache at a tertiary care hospital, Karachi, Pakistan. Brain imaging of both patients revealed a pituitary macroadenoma. Hornonal workup of our patients is shown below.

Hormonal workup of case 1 and case 2

Figure Legend: FSH, Follicle stimulating hormone; FT4, Free Thyroxine; LH, luteinizing hormone; MIU/ml, milli-international units per milliliter; ng/dl, nanogram per deciliter; ug/dl, microgram per deciliter; GH, Growth hormone; Both patients underwent transsphenoidal resection of the tumor and tissue histopathology confirmed pituitary adenoma. Postoperatively, improvement in hormonal profile was observed along with the resolution of visual disturbances and headaches.


Laboratory Parameters	Case 1		Case 2		Normal values
Laboratory Parameters	Pre- Surgery	Post- Surgery	Pre- Surgery	Post- Surgery	Normal values
FSH	36.66	4.97	13.61		1.4–15.4#160;MIU/ml
LH	7.09	0.99	4.45		1.2–7.8#160;MIU/ml
Testosterone	952.7	176.8	> 1500	20.14	193–740#160;ng/dl
Cortisol	2.60	7.40	12.60	11.10	4.3–22.4#160;ng/dl
FT4	0.69	1.65	0.84	0.88	0.89–1.76#160;ng/dl
Prolactin	12.40		36.80		3–14.7#160;ng/ml
GH	< 0.50	0.06	0.13		2.0–5.0#160;ng/ml

Conclusion

Thus, functional gonadotroph adenoma should be considered in the presence of elevated testosterone/estrogen and normal or elevated follicle-stimulating hormone (FSH)/ luteinizing hormone (LH). Early diagnosis leads to a better outcome.

Keyword: Pituitary Neoplasms, Gonadotrophs, Follicle Stimulating Hormone, Luteinizing Hormone, Adenoma, Testosterone