Endocrine Abstracts

Introduction: Pituitary adenomas are the most frequent sellar tumors in adults. Depending on their hormonal profile in vivo and on immunohistochemistry, they present different clinical profiles and progression outcomes. Thus, we report a case of an FSH-secreting pituitary adenoma.

Observation: The patient SG is 63 years old. He complained of intermittent headaches associated with a progressive decrease in visual acuity. Ophthalmological examination revealed bilateral papillary atrophy and visual field amputation. A pituitary MRI revealed a 23 mm pituitary macroadenoma responsible for a bulging sellar diaphragm and a rightward deviation of the pituitary stalk. It came into contact with the optic chiasm and engulfed both internal carotid arteries. The patient reported the onset of erectile dysfunction, decreased libido, and disappearance of morning erections without gynecomastia. The hormonal evaluation showed the integrity of the corticotropic and thyroid axis, a hypogonadotropic hypogonadism profile, and disconnection hyperprolactinemia (37.5ng/ml). Due to the threatened visual prognosis, the patient underwent surgery. Intraoperative observation highlighted the presence of a hemorrhagic tumor adherent to the lateral wall of the cavernous sinus which could not be completely resected. The anatomopathological study concluded with an FSH-secreting pituitary adenoma (FSHoma). Adjuvant external radiotherapy is recommended for this patient.

Discussion: FSHomas secrete increased gonadotropins and/or their subunits in an often biologically inactive form. Their clinical presentation is poor and remains dominated by the mass effect responsible for visual complications and signs of hypopituitarism. Surgery remains the only effective treatment option.

References: 1. Osamura, Robert Y., et al. "Pathology of the human pituitary adenomas." Histochemistry and cell biology 130.3 (2008): 495-507. 2. Dahlqvist, Per, et al. "Testicular enlargement in a patient with a FSH-secreting pituitary adenoma." Endocrine 37.2 (2010): 289-293.