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Gonadotropic Pituitary Adenoma

Gonadotrophin Secreting Adenoma of Pituitary


Presentation

  • Case presentation A 67-year-old man was presented to the emergency department complaining of headache ongoing for 24h. He also reported ptosis of the right eye that occurred acutely 6h in advance of presentation.[edmcasereports.com]
  • Hyperprolactinemia Prolactin secreting pituitary adenomas present four times as frequently in women as in men. It should be noted that both the age of presentation and symptomatology at presentation are markedly different in the sexes.[med.virginia.edu]
  • Case Presentation - MT is a 54 year old male who presented with a chief complaint of recent severe headaches and visual blurring. The history was notable for approximately 6 months of diminished libido and progressive impotence.[pituitary.mgh.harvard.edu]
  • Clinical Presentation Because endocrine-inactive tumors do not cause hypersecretion syndromes, they usually present with symptoms associated with mass effect.[ncbi.nlm.nih.gov]
  • He presented to the Emergency Department on post-operative day eight with nausea, vomiting, and mild epistaxis.[ncbi.nlm.nih.gov]
Difficulty Walking
  • CASE REPORT: A 43-year-old male with a history of 5 years of erythrocytosis presented with severe headache, orthostatic dizziness, and difficulty walking.[hormones.gr]
Morning Sickness
  • Hydrocortisone 10 mg daily replaced cortisone acetate; the dose was increased according to the symptoms of morning sickness.[journals.lww.com]

Workup

  • Workup of the Pituitary “Incidentaloma” Pituitary tumors are among the most common brain tumors. Autopsy and radiology studies have placed the incidence between 14% and 22%.[oregonclinic.com]
  • […] adenomas show numerous enlarged mitochondria with loss of cristae and presence of electron dense tubular structures ( Brain Pathol 2012;22:443 ) Molecular / cytogenetics description No specific molecular characteristics in routine clinical diagnostic workup[pathologyoutlines.com]
  • GENERAL PRINCIPLES OF DIAGNOSIS AND TREATMENT Patients presenting with signs and symptoms suggestive of a pituitary adenoma require a comprehensive workup and treatment plan reflecting a strong interdisciplinary effort with endocrinologists, neurosurgeons[med.virginia.edu]
  • While a majority of patients with endogenous Cushing syndrome have thyrotrophic adenomas (called Cushing Disease - see below), other tumors should also be considered as part of the endocrinologic workup, including adrenal tumors and especially ACTH-secreting[eyewiki.aao.org]
Erythroblast
  • Erythropoiesis is a process induced hormonally by erythropoietin and testosterone, which takes effect directly on bone marrow at polychromatophilic erythroblast level and enhances the synthesis of ribosomal RNA. 36 Some recent publications have reported[hormones.gr]
Glucose Decreased
  • Thirty minutes after insulin bonus injection, plasma glucose decreased to 1.7 mmol/L, and serum cortisone only elevated to 11.05 μg/dL (Figure 2, Table 2).[journals.lww.com]

Treatment

  • A combination treatment with long-acting release (LAR) octreotide (Sandostatin LAR, 30 mg/monthly) and the dopaminergic agonist cabergoline (0.5 mg twice/weekly) was introduced, and hydroxyurea treatment was discontinued.[journals.aace.com]
  • Surgery can also be used when drug treatment doesn't work. Radiation may be used if drug treatment and surgery do not work.[cancer.org]
  • Limited Class III evidence was identified for NFPA patients treated with observation (2 studies), primary radiation-based treatment (3 studies), or medical treatment (8 studies).[cns.org]
  • Treatment Surgery remains the primary treatment for patients with inactive adenomas, with the goals to relieve the mass effect, restore pituitary function, and obtain a tissue diagnosis.[ncbi.nlm.nih.gov]
  • Trials are often designed to treat a certain stage of cancer, either as the first form of treatment offered, or as an option for treatment after other treatments have failed to work.[oncolink.org]

Prognosis

  • […] secretory granules and that a majority of them synthesize FSH, LH, and the α-subunit, with a smaller subset producing other anterior pituitary hormones that do not show clinical manifestations. 63 However, no clear and consistent difference in treatment or prognosis[ncbi.nlm.nih.gov]
  • Learn more People with pituitary tumors generally have a good prognosis, but even the most benign forms can regrow after treatment and become problematic. In rare cases, pituitary tumors can become cancerous.[mskcc.org]
  • Prognosis Usually favourable. Truly malignant metastatic behaviour is extremely rare. The unresponsiveness to pharmacological treatment is associated with more aggressive behaviour.[atlasgeneticsoncology.org]
  • "Expression of estrogen receptor alpha is associated with prolactin pituitary tumor prognosis and supports the sex-related difference in tumor growth.". Eur J Endocrinol 172 (6): 791-801. doi : 10.1530/EJE-14-0990. PMID 25792376.[librepathology.org]
  • Diagnosis, management, and prognosis of pituitary tumors. In: Thapar K, Kovacs K, Scheithauer BW, Lloyd RV, eds. Diagnosis and Management of Pituitary Tumors. Totowa, N.J.: Humana Press; 2001:165–172. 7.[aafp.org]

Etiology

  • J Clin Endocrinol Metab 92: 10–25 CrossRef PubMed Google Scholar Brito VN, Latronico AC, Arnhold IJ et al. (2008) Update on the etiology, diagnosis and therapeutic management of sexual precocity.[springerlink.com]
  • Hypogonadism is detected in up to 96% of patients with pituitary macroadenomas ( 1 cm) and is usually associated with inappropriately normal or decreased serum gonadotropin levels, indicating central hypogonadism The etiology of hypogonadism in this setting[pituitary.mgh.harvard.edu]
  • Hyperprolactinemia Present Biologically inactive form of prolactin, with no pathologic association Useful to check in patients with hyperprolactinemia who have moderate elevations (100 to 300 mcg per L [4,348 to 13,043 pmol per L]) of serum prolactin with unknown etiology[aafp.org]
  • […] of somatotrophs, lactotrophs and thyrotrophs SF-1 (steroidogenic factor 1): gonadotroph cell differentiation T-PIT (T-box family member TBX19): proopiomelanocortin (POMC) lineage with differentiation of corticotrophs ( Acta Neuropathol 2017;134:521 ) Etiology[pathologyoutlines.com]

Epidemiology

  • Dtsch Arztebl Int 106: 377–382 PubMedCentral PubMed Google Scholar Gravholt CH (2004) Epidemiological, endocrine and metabolic features in Turner syndrome.[springerlink.com]
  • Epidemiology of pituitary macroadenomas Frequency of pituitary macroadenomas Pituitary tumors found at autopsy in 25% of cases.[minclinic.ru]
  • Each entity is extensively discussed with information on clinicopathological, epidemiological, immunophenotypic and genetic aspects of these diseases. The book is an authoritative, concise reference, prepared by 150 authors from 20 countries.[books.google.com]
  • Epidemiologic estimates indicate an annual incidence of 8.2 to 14.7 cases per 100,000 people. [2] Approximately 30% of pituitary adenomas are clinically nonfunctional, as defined by the absence of excessive hormone secretion found by various endocrinological[neurologyindia.com]
  • PMID 12763000 The epidemiology of endocrine tumours. Monson JP Endocrine-related cancer. 2000 ; 7 (1) : 29-36. PMID 10808194 Incidence, Pathology, and Recurrence of Pituitary Adenomas: Study of 647 Unselected Surgical Cases.[atlasgeneticsoncology.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology of pituitary macroadenomas Pituitary macroadenoma is a benign epithelial neoplasm composed of adenohypophysial cells. Primary malignant tumors of the pituitary gland are quite rare.[minclinic.ru]
  • Rizzo Journal of Neuro-Ophthalmology. 2016; 36(3): 313 9 Revisitation of autoimmune hypophysitis: knowledge and uncertainties on pathophysiological and clinical aspects Giuseppe Bellastella,Maria Ida Maiorino,Antonio Bizzarro,Dario Giugliano,Katherine[ijem.in]
  • […] tumor patients Differential diagnosis of thyrotropin-secreting pituitary tumor versus thyroid hormone resistance Differential diagnosis of constitutional delay of puberty versus hypogonadotrophic hypogonadism Clinical Information Discusses physiology, pathophysiology[mayomedicallaboratories.com]
  • […] pituitary gland C75.1 Sites Majority occur in sella turcica within the adenohypophysis / anterior pituitary lobe Rare examples occur in extrasellar region on pituitary stalk Rare prolactinomas as part of ovarian teratoma ( Endocr Pathol 2014;25:321 ) Pathophysiology[pathologyoutlines.com]
  • N Engl J Med 358: 709–715 CrossRef PubMedCentral PubMed Google Scholar Themmen APN, Huhtaniemi IT (2000) Mutations of gonadotropins and gonadotropin receptors: Elucidating the physiology and pathophysiology of pituitary-gonadal function.[springerlink.com]

Prevention

  • Prevention Pituitary adenomas are not associated with any known lifestyle or environmental risk factors, so there are no available methods to prevent the condition.[innerbody.com]
  • Large tumours can also prevent normal hormone secretion by other parts of the pituitary gland causing symptoms of hormone deficiency. Sometimes they are more difficult to control.[pituitary.org.uk]
  • Consequent hypogonadism reduces testosterone, preventing or slowing prostate cancer cell proliferation.[edmcasereports.com]
  • Administration during the follicular phase of a normal cycle may result in premature ovulation and appropriate measures are advised to prevent an unwanted pregnancy in these circumstances.[medicines.org.uk]

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