Functional Gonadotroph Adenomas in Male Patients: Clinical Characteristics, Surgical Outcomes, and Hormonal Follow-up

Functional gonadotroph adenomas (FGAs) are rare pituitary neuroendocrine tumors derived from the steroidogenic factor 1 (SF-1) lineage that present clinically with elevated serum levels of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH). While previous research has predominantly featured female patients, this study specifically aims to better understand the clinical characteristics and postoperative outcomes of FGAs in male patients.

A retrospective review of medical records from a single institution, encompassing 1306 pituitary adenomas, identified 12 male patients who underwent transsphenoidal resection for FGAs.

Mean (SD) age was 66.5 (9.4) years. Mean (SD) size was 28.8 (21.6) mm. Preoperatively, all patients exhibited elevated FSH (mean [SD] = 21.9 (7.0) mIU/mL, range = 13.7-34.9 mIU/mL, normal = 1.5-12.4 mIU/mL). Mean (SD) preoperative LH was 6.5 (5.9) mIU/mL (range = 1.3-20.9 mIU/mL, normal = 1.8-8.6 mIU/mL), and it was elevated in 2 patients. 3 patients possessed preoperative testosterone dysfunction (2 with low total and free testosterone, 1 with low total testosterone). All patients were symptomatic preoperatively, with fatigue, headache, and visual problems being the most common. Gross total resection was achieved in 9 patients (75.0%). Postoperatively, mean (SD) FSH was 18.5 (17.8) mIU/mL (range = 0.7-53.6 mIU/mL), and remained elevated in 5 patients. LH remained elevated in 2 out of the 2 patients with elevated preoperative LH. 6 patients (50.0%) were prescribed testosterone gel postoperatively. 41.7% of patients did not report symptoms postoperatively.

All patients presented with elevated FSH levels, and a minority also had elevated LH or low testosterone. Surgery led to a reduction in symptomatic complaints in many cases, and the majority achieved gross total resection. Given that most patients continue to exhibit hormonal abnormalities postoperatively, close follow-up and thorough investigation of gonadal dysfunction is essential, as many patients may require ongoing medical management.