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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Presentation of a functional pituitary adenoma as a significant decrease in prostate-specific antigen level in a
Aaron B Grotas1, Harris M Nagler
1Department of Urology, Beth-Israel Medical Center, Albert Einstein College of Medicine, New York, New York 10003, USA.
The Canadian Journal of Urology
|December 26, 2006
Summary
A pituitary tumor caused a prostate cancer patient's prostate-specific antigen (PSA) levels to drop unexpectedly. This case highlights the impact of prolactin on the hypothalamic-pituitary-gonadal axis and its effect on PSA levels.
Area of Science:
- Endocrinology
- Oncology
- Urology
Background:
- Testosterone stimulates prostate-specific antigen (PSA) production and release.
- Testosterone synthesis relies on a healthy hypothalamic-pituitary-gonadal (HPG) axis.
- Elevated prolactin levels can impair the HPG axis, reducing gonadotropins and testosterone.
Observation:
- A prostate cancer patient on watchful waiting experienced a rapid PSA decline over three months.
- The patient had initially presented with elevated PSA levels.
- An asymptomatic prolactin-secreting pituitary macroadenoma was discovered.
Findings:
- The prolactin-secreting pituitary macroadenoma likely caused hyperprolactinemia.
- Hyperprolactinemia disrupted the patient's HPG axis, leading to decreased testosterone.
- Reduced testosterone levels resulted in the significant decrease in PSA.
Implications:
- This case underscores the critical link between endocrine function and prostate cancer biomarker levels.
- Monitoring prolactin may be relevant in select prostate cancer patients with unexplained PSA fluctuations.
- Pituitary adenomas can have systemic effects impacting cancer management.
