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Karlekar M, Diwaker C, Sarathi V, Lila A, Sharma A, Memon SS, Patil V, Bandgar T. Gonadotropin-secreting and thyrotropin-secreting pituitary adenomas: A single-center experience. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 68:e230072. [PMID: 37988667 PMCID: PMC10916838 DOI: 10.20945/2359-4292-2023-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/23/2023] [Indexed: 11/23/2023]
Abstract
Objective Data regarding rare FPAs from India, a resource limited setting, are limited. We describe a case series of rare FPAs from a single center in western India. Materials and methods This was a retrospective case record review of patients diagnosed between January 2010 and July 2022. The diagnosis was based on biochemical(inappropriately elevated serum FSH/LH) and pathologic (positive immunostaining for FSH/LH) features in patients with FGA, and elevated serum thyroid hormones and normal/elevated TSH in patients with TSHomas. Results We identified 11 patients with a total of six FGAs (median age 43.5 years, five men, one FGA cosecreting TSH, median largest dimension 40 mm, range 33-60 mm) and six TSHomas (median age 34.5 years, four women, two TSHomas cosecreting GH, median largest dimension 42.5 mm, range 13-60 mm). Symptoms of sellar mass effects led to pituitary imaging in most patients with FGA. Patients with TSHomas had symptoms of excess hormone secretion (GH/TSH) or sellar mass effects. The TSHomas that cosecreted GH/FSH were larger than those secreting only TSH. Transsphenoidal resection was the most common first-line therapy but significant residual disease was frequent (3 out of 6 FGAs and 4 out of 5 TSHomas). Conclusion This is the first and second case series of FGAs and TSHomas, respectively, from India. In this study, TSHomas presented at younger age, were larger andhad low surgical cure rates.
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Affiliation(s)
- Manjiri Karlekar
- Department of Endocrinology, Seth G.S. Medical College and KEM Hospital, Mumbai, India
- Manjiri Karlekar and Chakra Diwaker have contributed equally as first authors
| | - Chakra Diwaker
- Department of Endocrinology, Seth G.S. Medical College and KEM Hospital, Mumbai, India
- Manjiri Karlekar and Chakra Diwaker have contributed equally as first authors
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Anurag Lila
- Department of Endocrinology, Seth G.S. Medical College and KEM Hospital, Mumbai, India,
| | - Anima Sharma
- Department of Endocrinology, Seth G.S. Medical College and KEM Hospital, Mumbai, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth G.S. Medical College and KEM Hospital, Mumbai, India
| | - Virendra Patil
- Department of Endocrinology, Seth G.S. Medical College and KEM Hospital, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth G.S. Medical College and KEM Hospital, Mumbai, India
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He Y, Gao YT, Sun L. Functioning gonadotroph adenoma with hyperestrogenemia and ovarian hyperstimulation in a reproductive-aged woman: A case report and review of literature. World J Clin Cases 2023; 11:1341-1348. [PMID: 36926127 PMCID: PMC10013118 DOI: 10.12998/wjcc.v11.i6.1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/28/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Functioning gonadotroph adenomas are extremely rare pituitary tumors that secrete gonadotropins and exhibit distinct clinical manifestations. Here, we report a case of functioning gonadotroph adenoma in a reproductive-aged woman and discuss its diagnosis and management.
CASE SUMMARY A 21-year-old female patient with abdominal pain, irregular menstruation, hyperestrogenemia, and an ovarian mass was included. Brain magnetic resonance imaging (MRI) revealed a pituitary macroadenoma, and transsphenoidal surgery relieved her clinical symptoms. Before transsphenoidal surgery, plasma CA125, estradiol levels were elevated, while prolactin, luteinizing hormone, follicle-stimulating hormone, PROG, cortisol, FT4, thyroid-stimulating hormone, parathyroid hormone, and GH levels were maintained at normal levels. After transsphenoidal surgery, the patient was diagnosed with a functioning gonadotroph adenoma. During follow-up, pelvic ultrasound confirmed normal-sized ovaries in the patient, the menstrual cycle returned to regular, and her hormones were maintained within a normal range. There was no evidence of tumor recurrence after two years of follow-up.
CONCLUSION Early diagnosis of functioning gonadotroph adenomas should be considered in patients with hyperestrogenism, irregular menstruation, large or recurrent ovarian cysts, and visual field defects. Pituitary MRI should be performed, and transsphenoidal surgery is recommended for the management of this disease.
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Affiliation(s)
- Ying He
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
| | - Yu-Tao Gao
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
| | - Li Sun
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
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Even-Zohar N, Greenman Y. Current medical treatment and perspective in gonadotroph tumors. Best Pract Res Clin Endocrinol Metab 2022; 36:101685. [PMID: 35871905 DOI: 10.1016/j.beem.2022.101685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gonadotroph cell adenoma is the most common clinically nonfunctioning pituitary adenoma; and is pathologically defined by immunopositivity for SF-1, GATA2 and ER-α. Most tumors also stain for follicle stimulating hormone and luteinizing hormone β-subunits, but are usually hormonally silent and discovered incidentally or due to local mass effects. Complete transsphenoidal resection should be attempted when surgery is indicated. Post-surgical treatment can include radiation of the tumor remnant and medical treatment. Among medical treatments, dopamine agonists show the best evidence for preventing the need for recurrent surgery or radiation, and should be considered in patients with relatively bulky remnants or who have high risk features associated with tumor progression. Temozolomide is indicated for aggressive adenomas and carcinomas. Less well-established treatments include somatostatin receptor ligands, peptide receptor radionucleotide therapy and immunomodulatory agents.
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Affiliation(s)
- Naomi Even-Zohar
- Institute of Endocrinology, Diabetes, Metabolism, and Hypertension, Tel Aviv-Sourasky Medical Center, Israel.
| | - Yona Greenman
- Institute of Endocrinology, Diabetes, Metabolism, and Hypertension, Tel Aviv-Sourasky Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Ntali G, Capatina C. Updating the Landscape for Functioning Gonadotroph Tumors. Medicina (B Aires) 2022; 58:medicina58081071. [PMID: 36013538 PMCID: PMC9414558 DOI: 10.3390/medicina58081071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Functioning gonadotroph adenomas (FGAs) are rare tumors, as the overwhelming majority of gonadotroph tumors are clinically silent. Literature is based on case reports and small case series. Gonadotroph tumors are poorly differentiated and produce and secrete hormones inefficiently, but in exceptional cases, they cause clinical syndromes due to hypersecretion of intact gonadotropins. The clinical spectrum of endocrine dysfunction includes an exaggerated response of ovaries characterized as ovarian hyperstimulation syndrome (OHSS) in premenopausal females and adolescent girls, testicular enlargement in males, and isosexual precocious puberty in children. Transsphenoidal surgery and removal of tumor reduces hormonal hypersecretion, improves endocrine dysfunction, and provides tissue for further analysis. Medical therapies (somatostatin analogues, dopamine agonists, GnRH agonists/antagonists) are partially or totally ineffective in many cases, especially with respect to antitumor effect. This review aims to update recent literature on these rare functioning tumors and highlight their therapeutic management.
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Affiliation(s)
- Georgia Ntali
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, 10676 Athens, Greece
- Correspondence:
| | - Cristina Capatina
- Department of Endocrinology, Carol Davila UMPh, 011863 Bucharest, Romania
- Department of Pituitary and Neuroendocrine diseases, CI Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
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Mamedova EO, Selivanova LS, Potapova KA, Buryakina SA, Azizyan VN, Grigoriev AY, Belaya ZE. [A rare case of a functioning gonadotroph tumor accompanied by erythrocytosis in an elderly man]. ACTA ACUST UNITED AC 2021; 67:37-44. [PMID: 34297500 DOI: 10.14341/probl12758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/21/2021] [Accepted: 06/13/2021] [Indexed: 11/06/2022]
Abstract
Functioning gonadotroph adenomas are rare pituitary tumors secreting one or two gonadotropins (follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH)), which are hormonally active. In the majority of cases, gonadotroph tumors are endocrinologically "silent" and make up more than a half of non-functioning pituitary adenomas. In this article we describe a rare clinical case of LH/FSH-secreting pituitary macroadenoma with bitemporal hemianopsia in a 62-year-old man. The patient underwent transnasal transsphenoidal adenomectomy, leading to remission. The distinctive feature of this case is the presence of secondary erythrocytosis due to endogenous hyperandrogenism, which required several blood exfusions to normaliza the level of hematocrit before surgery. It is noteworthy that clinical signs of erythrocytosis were present long before visual impairment. This clinical case demonstrates difficulties in the early diagnosis of functioning gonadotroph adenomas.
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Graillon T, Castinetti F, Chabert-Orsini V, Morange I, Cuny T, Albarel F, Brue T, Dufour H. Functioning gonadotroph adenoma with severe ovarian hyperstimulation syndrome: A new emergency in pituitary adenoma surgery? Surgical considerations and literature review. ANNALES D'ENDOCRINOLOGIE 2019; 80:122-127. [DOI: 10.1016/j.ando.2018.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/27/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
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Eisenberg A, Mersereau J, Buckley AF, Gratian L. MULTIPLE PITUITARY ADENOMAS WITH FUNCTIONAL FOLLICLE-STIMULATING HORMONE SECRETION LEADING TO OVARIAN HYPERSTIMULATION SYNDROME. AACE Clin Case Rep 2018; 5:e159-e163. [PMID: 31967024 DOI: 10.4158/accr-2018-0474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/15/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To present a rare case of multiple pituitary adenomas with a functional follicle-stimulating hormone component leading to ovarian hyperstimulation syndrome. Methods We present the clinical, laboratory, imaging, and pathologic findings along with a review of the literature. Results A 28-year-old female presented with 5 months of amenorrhea and abdominal pain. Physical exam was unremarkable. Labs revealed elevated prolactin (94 ng/mL), elevated estradiol (608 pg/mL), inappropriately normal follicle-stimulating hormone (10.2 mIU/mL), and suppressed luteinizing hormone (0.36 mIU/mL). Transvaginal ultrasound showed numerous large ovarian cysts bilaterally. Brain magnetic resonance imaging showed a 1.2-cm sellar mass. Various medical therapies were not tolerated due to side effects and the patient underwent gross total resection of the sellar mass with marked improvement in her symptoms and blood hormone levels, resumption of menstruation, and shrinkage of the ovarian cysts. Histologic examination revealed 3 separate staining patterns consistent with multiple pituitary adenomas. Conclusion Functioning gonadotroph adenomas are rare and often difficult to diagnose, though in premenopausal women they can lead to the distinct clinical presentation of spontaneous ovarian hyperstimulation syndrome. The favored treatment approach is surgical as it has the highest reported success rate. Recurrence is not uncommon and long-term surveillance is recommended. Given limited data on long-term follow-up, the role of available therapies is not well defined, and further research is needed. To our knowledge, this is the first reported case of multiple pituitary adenomas that included a functional gonadotroph component.
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Early recognition of aggressive pituitary adenomas: a single-centre experience. Acta Neurochir (Wien) 2018; 160:49-55. [PMID: 29170844 DOI: 10.1007/s00701-017-3396-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/13/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pituitary adenomas are usually considered benign tumours, although some of them can exhibit an aggressive behaviour. Patients with clinically aggressive pituitary adenomas are frequently diagnosed with larger masses, and may present an earlier recurrence (or persistence) after surgery. Our aim was to characterise the clinical, histopathological and radiological features of patients with aggressive pituitary adenoma, in order to correlate their clinical behaviour with the response to treatment plan. METHOD We considered an aggressive pituitary adenoma on the basis of radiological features (size, local invasion), pathological reports (atypical adenoma: MIB-1 >3%, p53 immunoreactivity, increased mitotic activity) and clinical aspects (response to surgery, radiotherapy and medical treatment). RESULTS Among our cohort of 582 patients, we considered 102 subjects with aggressive pituitary adenomas (18%, 56 male and 46 female): 14 adrenocorticotrophic hormone (ACTH)-secreting, 18 growth hormone (GH)-secreting, 23 prolactin (PRL)-secreting and 47 non-secreting, with a median follow-up of 5 years. In the whole cohort, 75% of patients with aggressive pituitary adenomas presented invasion of surrounding structure, especially GH-secreting, PRL-secreting and non-secreting. Besides invasion, their remission rate after surgery, radiotherapy or medical treatment was similar, irrespective of hormonal secretion. Surgery was the most performed treatment (overall remission rate of 24%), especially in those patients with ACTH- or GH-secreting adenoma, and 22% of patients were submitted to radiotherapy, with a remission rate of 45% after a median of 3 years. Two consecutive years of medical treatment, in patients with secreting pituitary adenoma, achieved disease control in 41% of them. Considering pathological reports, 24% of cases were defined as atypical adenomas; radiological characteristics, responses to medical treatment and remission rates were similar among patients with typical and atypical adenoma. CONCLUSIONS We proposed a new and comprehensive definition of aggressive pituitary adenoma, based upon radiological, clinical and pathological features. In a selected cohort of patients, radiological invasion resulted in the most common marker to describe the aggressive behaviour of pituitary adenoma. Surgery, radiotherapy and medical treatment (the latter only in secreting adenoma) achieved disease control in half of the patients with aggressive adenoma, especially surgery in those with ACTH-oma and medical treatment in those with GH- and PRL-secreting adenoma. Nevertheless, radiological, clinical or atypical features did not affect the outcome.
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Patra S, Biswas SN, Datta J, Chakraborty PP. Hypersomatotropism induced secondary polycythaemia leading to spontaneous pituitary apoplexy resulting in cure of acromegaly and remission of polycythaemia: 'The virtuous circle'. BMJ Case Rep 2017; 2017:bcr-2017-222669. [PMID: 29222208 DOI: 10.1136/bcr-2017-222669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A young man with subtle clinical features suggestive of hypersomatotropism presented with acute-onset severe headache. Relevant investigations confirmed polycythaemia and growth hormone (GH)-secreting pituitary macroadenoma with apoplexy. Secondary polycythaemia and myeloproliferative disorders were ruled out. At follow-up after 3 months, resolution of polycythaemia and acromegaly was observed, evident on normal haemoglobin levels, a normocellular marrow, and normal insulin-like growth factor-1 (IGF-1) with glucose-suppressed GH levels. Direct mitogenic properties of GH-IGF-1 axis on bone marrow progenitor cells may very rarely lead to erythroid hyperplasia and subsequent polycythaemia, reversible with successful therapy of acromegaly. In this case, polycythaemia secondary to hypersomatotropism likely resulted in pituitary apoplexy with subsequent remission of both acromegaly and resultant polycythaemia.
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Affiliation(s)
- Shinjan Patra
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Sugata Narayan Biswas
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Joydip Datta
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
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Angelousi A, Nikolopoulos G, Kolomodi D, Rontogianni D, Alexandraki K, Boutzios G, Kaltsas G. Secondary Polycythemia Attributed To An Incidentally Discovered Luteinizing Hormone–Secreting Pituitary Adenoma: A Case Report. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161255.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mittal K, Koticha R, Dey AK, Anandpara K, Agrawal R, Sarvothaman MP, Thakkar H. Radiological illustration of spontaneous ovarian hyperstimulation syndrome. Pol J Radiol 2015; 80:217-27. [PMID: 25960820 PMCID: PMC4418209 DOI: 10.12659/pjr.893536] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/26/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of radiology is of utmost importance not only in diagnosing s-OHSS but also in ruling out other cystic ovarian diseases and to determine the underlying etiology and course of the disease. We presented a radiological algorithm for diagnosing the various causes of s-OHSS. CASE REPORT A 26-year-old female, gravida one was referred to radiology department with history of lower abdominal pain, nausea and vomiting since 2 days which was gradual in onset and progression. The patient had no significant medical and surgical history. CONCLUSIONS This article illustrates and emphasizes that diagnosis of s-OHSS and its etiology can be completely evaluated radiologically. Biochemical markers will confirm the radiological diagnosis.
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Affiliation(s)
- Kartik Mittal
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Raj Koticha
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Amit K Dey
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Karan Anandpara
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Rajat Agrawal
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Madhva P Sarvothaman
- Department of Obstetrics and Gynaecology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Hemangini Thakkar
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
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Ceccato F, Lombardi G, Manara R, Emanuelli E, Denaro L, Milanese L, Gardiman MP, Bertorelle R, Scanarini M, D’Avella D, Occhi G, Boscaro M, Zagonel V, Scaroni C. Temozolomide and pasireotide treatment for aggressive pituitary adenoma: expertise at a tertiary care center. J Neurooncol 2015; 122:189-96. [DOI: 10.1007/s11060-014-1702-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/19/2014] [Indexed: 10/24/2022]
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