Endocrine Abstracts

Introduction

Gonadotropin-secreting adenomas occupy nowadays the third or fourth place of all pituitary adenomas (12 to 17% of pituitary adenomas operated on), after prolactinomas, somatotropic adenomas and corticotropic adenomas. They can be either accompanied by hypersecretion of gonadotropins or their dosable subunits in plasma recognized only by immunocytochemistry. Gonadotropic adenomas are not uncommon. They are often misknown because they lack any particular clinical expression. Indeed, they are most often revealed at the macro adenoma stage by a tumor syndrome or signs of anterior pituitary insufficiency. The objective of our work is to describe the epidemiological, diagnostic and therapeutic aspects of gonadotropic adenomas.

Material and methods

This is a retrospective study that focused on the cases of pituitary adenomas, collected at the Endocrinology – Diabetology and Nutrition Department of Mohammed VI University Hospital in Oujda, over a period of 6 years and a half. The data were collected from medical records and the analysis was done by SPSS version 21 software.

Results

The gonadotropic adenoma represents 4% of all pituitary adenomas. The average age of our patients was 44.6 years, mostly present in women (sex ratio: 2/1). The reason of consultation was a pituitary tumor syndrome with a decrease in visual acuity in the majority of cases. The average body mass index was 28.2 ± 5.01 kg/m². All of our patients had a macro adenoma with signs of ophthalmologic and neurological impact. In our series, all the patients were symptomatic and showed at least one endocrine sign; the most common one being hypogonadism in 66.6% of cases and isolated amenorrhea in 33.3% of the cases. Regarding biological assessments, only one patient had a high level of FSH and LH gonadotropins with low estradiol and a high level of subunits, while the rest of the patients had hypogonadotropic hypogonadism. All our patients benefited from a partial removal of the macro adenoma using endoscopic transsphenoidal surgery, with simple post-operative care. A revision surgery was noted in one patient and all our patients had a corticotropic and thyroid hormone substitution postoperatively.

Discussion/conclusion

Gonadotropic pituitary adenomas, now recognized with greater frequency with the progress of immunocytochemistry, have become an important chapter in pituitary pathology. A better analysis of the secretion of gonadotropins and their free subunits, with the help of stimulation tests if necessary, allows a significant number of these adenomas to be recognized.

Keywords: gonadotropic pituitary adenoma, diagnosis