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Nonfunctioning pituitary macroadenoma presenting with mild hyperprolactinemia and amenorrhea
1Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, USA.
Objective:
To describe a patient with a clinically nonfunctioning pituitary macroadenoma who presented with mild hyperprolactinemia and amenorrhea.
Design:
Case report.
Setting:
Tertiary care medical facility.
Patient(S):
A 44-year-old woman with a 6-month history of amenorrhea.
Intervention(S):
Pituitary testing, magnetic resonance imaging of the sella turcica, and transsphenoidal surgery.
Main Outcome Measure(S):
Pituitary function testing, magnetic resonance imaging, and return of menstrual cycles.
Result(S):
Baseline laboratory data revealed a serum prolactin level of 34 ng/mL (normal range, 3-20 ng/mL), normal thyroid function test results, and an FSH level of 6.7 mIU/mL. A second fasting prolactin level was 48 ng/mL. Magnetic resonance imaging of the sella turcica revealed a pituitary macroadenoma measuring 1.4 x 3.2 cm. Further testing of baseline pituitary function revealed normal findings. The patient underwent an uncomplicated transsphenoidal resection of the pituitary tumor and maintained normal pituitary function. Pathologic evaluation revealed a pituitary adenoma that stained positive for FSH and focally for the alpha subunit. The adenoma stained negative for GH, prolactin, ACTH, LH, and TSH.
Conclusion(S):
This patient had a nonsecreting gonadotroph macroadenoma that resulted in hypogonadotropic hypogonadism along with mild hyperprolactinemia, presumably secondary to interruption of normal transport down the pituitary stalk.