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Gonadotroph cell pituitary adenomas.

P J Snyder1

  • 1Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia.

Endocrinology and Metabolism Clinics of North America
|September 1, 1987
PubMed
Summary

Gonadotroph cell adenomas are more common than previously thought, often presenting as large pituitary tumors causing vision loss. Diagnosis relies on hormonal evaluation, and treatment typically involves surgery and radiation therapy.

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Area of Science:

  • Endocrinology
  • Oncology
  • Neurosurgery

Background:

  • Gonadotroph cell adenomas are a subtype of pituitary adenomas.
  • Their prevalence may be underestimated in previous studies.
  • These adenomas often present as macroadenomas, leading to mass effects.

Purpose of the Study:

  • To investigate the prevalence and characteristics of gonadotroph cell adenomas.
  • To describe the clinical and hormonal profiles of patients with these adenomas.
  • To evaluate current management strategies and their outcomes.

Main Methods:

  • Retrospective analysis of pituitary adenoma cases.
  • Clinical data review, including patient history, physical examination, and visual assessment.
  • Hormonal assays measuring follicle-stimulating hormone (FSH), luteinizing hormone (LH), alpha subunit, and testosterone levels.
  • Assessment of hormonal responses to thyrotropin-releasing hormone (TRH).
  • Review of treatment modalities such as transsphenoidal surgery, radiation therapy, and medical management.

Main Results:

  • Prevalence in pituitary macroadenomas was 17% (24% including alpha-subunit-only secreting adenomas).
  • Patients are typically middle-aged men with normal pubertal and fertility histories, presenting with visual impairment due to adenoma size.
  • Common hormonal features include FSH hypersecretion, often with FSH-beta and alpha subunits, and sometimes LH-beta.
  • Some adenomas hypersecrete intact LH causing supranormal testosterone; others cause secondary hypogonadism via compression.
  • TRH stimulation can elicit FSH and LH-beta secretion.
  • Surgery improves vision and hormonal abnormalities; radiation reduces FSH hypersecretion.

Conclusions:

  • Gonadotroph cell adenomas are a significant subset of pituitary macroadenomas, often presenting with mass effect and characteristic hormonal dysregulation.
  • Clinical and hormonal profiles aid in distinguishing them from other pituitary enlargements.
  • Transsphenoidal surgery followed by radiation is the primary management strategy, effectively improving vision and hormonal imbalances.
  • Hormonal monitoring is crucial for assessing treatment response.

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