Endocrine Abstracts

Gonadotropinomas secreting biologically active hormones, most commonly follicle-stimulating hormone (FSH), are a very rare pathology. The clinical manifestations depend on the gender and age of the patient. Men may observe enlarged testicles and erectile dysfunction. Reports on the results of the drug treatment are sporadic.

Objective: To describe a rare clinical case of an active giant FSH-secreting pituitary tumour in a 62-year-old man with the development of hyperandrogenism and secondary erythrocytosis. Patient Y. 62 years old applied to the neurosurgical centre with complaints of decreased vision. MRI examination revealed a giant tumor of the chiasmal-sellar region (maximum size 63 mm). Ophthalmological examination: decreased visual acuity in the OS- 0.3, OD- 0.9, left-sided hemianopsia. ?ormonal tests: FSH – 30 U/l (1,4-9,6), LH – 8,6 U/l (2,5-11), testosterone – 58 nmol/l (12-27); PRL, TSH, free T4, IGF-1, cortisol levels were within the reference values. The clinical blood test revealed secondary erythrocytosis (Hb – 199 g/l (130–170), erythrocytes – 6.5×10.12/l, Ht – 58% (40–51)), other parameters were unchanged. Urological examination revealed moderate diffuse changes in the prostate gland, testicular volume was within the age norm. The somatic status had no features. The localization and size of the tumour determined a high surgical risk. The patient refused the proposed surgical treatment. Cabergoline therapy was attempted. A normalization of laboratory values was observed on a 1.5 mg weekly basis for 3 months (FSH – 10 U/l; LH – 2,7 U/l, testosterone – 9,5 nmol/l; Hb – 162 g/l (130–170), erythrocytes – 5.3×10.12/l, Ht – 46%. During the following 7 years of follow-up a control MRI of the brain with contrast (the interval of investigation was 3–6 months during the first 3 years, then annually) showed tumor without significant changes in its size. Visual function remained at the same level.

Conclusion: In this case, the increase in sex hormones did not lead to a recognizable clinical syndrome. It should be remembered that endogenous hyperandrogenism may be the cause of erythrocytosis. The lack of progression of neurological symptoms for 7 years and the normalization of laboratory values, as a demonstration of the tumor’s “response” to therapy, allowed the patient to continue treatment with cabergoline. Further accumulation of clinical cases can determine the management for patients with active gonadotropinomas.