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Nonfunctioning pituitary macroadenoma presenting with mild hyperprolactinemia and amenorrhea
1Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, USA.
Fertility and Sterility
|October 16, 1999
Summary
A pituitary macroadenoma caused mild hyperprolactinemia and amenorrhea in a patient. Surgical removal of the nonfunctioning gonadotroph adenoma resolved symptoms and restored normal pituitary function.
Area of Science:
- Endocrinology
- Neuroscience
- Oncology
Background:
- Pituitary macroadenomas are tumors exceeding 10 mm in diameter.
- Clinically nonfunctioning adenomas do not secrete excess hormones but can cause symptoms through mass effect.
- Amenorrhea and hyperprolactinemia can be presenting symptoms of pituitary macroadenomas.
Observation:
- A 44-year-old woman presented with amenorrhea and mild hyperprolactinemia.
- Magnetic resonance imaging revealed a 1.4 x 3.2 cm pituitary macroadenoma.
- Pituitary function tests were normal except for elevated prolactin levels.
Findings:
- Pathologic evaluation confirmed a pituitary adenoma positive for FSH and focally for the alpha subunit, consistent with a nonsecreting gonadotroph adenoma.
- The patient underwent successful transsphenoidal resection of the tumor.
- Post-surgery, the patient maintained normal pituitary function and experienced a return of menstrual cycles.
Implications:
- This case highlights that nonfunctioning pituitary macroadenomas can present with hormonal disturbances like mild hyperprolactinemia and amenorrhea.
- The mechanism for hyperprolactinemia is likely stalk effect, disrupting dopamine inhibition of prolactin secretion.
- Surgical management is effective for symptomatic pituitary macroadenomas, leading to symptom resolution and preserved pituitary function.