Clinically functioning gonadotropin-secreting pituitary adenoma.

Area of Science:

• Endocrinology
• Neurosurgery
• Oncology

Background:

• Nonfunctional pituitary adenomas are common, but functioning gonadotroph adenomas are rare, presenting diagnostic challenges.
• Pituitary incidentalomas require endocrine evaluation to assess functional status.
• Functioning gonadotroph adenomas can manifest with diverse, often subtle, clinical symptoms.

Purpose of the Study:

• To present a case of a rare functioning FSH-secreting pituitary adenoma.
• To highlight the diagnostic considerations and multidisciplinary management of such rare tumors.
• To emphasize the effectiveness of surgical intervention for achieving remission.

Main Methods:

• Case report of a 42-year-old male with an incidental pituitary mass.
• Diagnostic workup included pituitary MRI, hormonal assays (FSH, testosterone), testicular ultrasound, and visual field testing.
• Treatment involved transsphenoidal resection of the pituitary adenoma.

Main Results:

• A 3 cm pituitary macroadenoma was identified, secreting FSH and potentially LH, leading to elevated testosterone and macroorchidism.
• Histopathology confirmed a gonadotroph-secreting adenoma with positive FSH staining.
• Post-surgery, hormone levels normalized, vision improved, and macroorchidism resolved within 12 weeks.

Conclusions:

• Functioning gonadotroph adenomas, though rare, necessitate thorough clinical and endocrine evaluation.
• Transsphenoidal surgery is the primary treatment, often leading to successful outcomes.
• Multidisciplinary team involvement is crucial for optimal management and achieving full remission.