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[Gonadotroph pituitary adenomas].
1Service d'Endocrinologie et des Maladies de la Reproduction, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris et Faculté de Médecine Paris-Sud Université Paris XI, 78, rue du Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex.
Annales D'Endocrinologie
|September 6, 2000
Summary
Clinically non-functional pituitary adenomas are often gonadotroph adenomas, secreting gonadotropins. Surgery is the primary treatment, though medical therapies for these pituitary tumors have shown limited success.
Area of Science:
- Endocrinology
- Oncology
- Neurosurgery
Background:
- Historically, pituitary adenomas were classified as functional or non-functional based on clinical presentation.
- Immunocytochemistry has revealed that many "non-functional" adenomas are, in fact, gonadotroph adenomas, accounting for 15-20% of all pituitary tumors.
- The pathogenesis of gonadotroph adenomas remains largely unknown, unlike other pituitary adenomas like somatotroph adenomas causing acromegaly.
Purpose of the Study:
- To review the current understanding of gonadotroph adenomas, including their diagnosis, clinical presentation, and management.
- To highlight the diagnostic challenges and the role of immunocytochemistry in identifying these tumors.
- To evaluate the effectiveness of different treatment modalities for gonadotroph adenomas.
Main Methods:
- Review of clinical data, pituitary imaging, and hormone assays in patients with gonadotroph adenomas.
- Analysis of immunocytochemistry findings in operated pituitary adenomas.
- Assessment of treatment outcomes, including surgery, radiotherapy, and medical therapies.
Main Results:
- Gonadotroph adenomas are frequently macroadenomas, often presenting with pituitary syndrome, particularly visual field defects.
- Anterior pituitary insufficiency is more common than gonad hyperstimulation.
- Elevated baseline gonadotropin or free alpha-subunit levels are observed in 30-50% of cases, with dynamic tests offering limited diagnostic value.
- Immunocytochemistry shows specific staining patterns for gonadotropin subunits in a subset of tumor cells.
- Surgery is the primary treatment, with radiotherapy potentially effective for residual tumors and recurrence.
- Medical treatments, including dopaminergic agonists, somatostatin analogs, and GnRH analogs, have yielded disappointing results.
Conclusions:
- Gonadotroph adenomas are a significant subset of pituitary adenomas, often misclassified as non-functional.
- Accurate diagnosis relies on a combination of clinical evaluation, imaging, hormone assays, and immunocytochemistry.
- Surgery remains the mainstay of treatment, with limited efficacy of current medical therapies for these pituitary tumors.