[Two cases of non-functional gonadotroph adenoma pituitary apoplexy following GnRH-agonist treatment revealing gonadotroph adenoma and pseudopituitary apoplexy after GnRH administration].
We report here two cases of pituitary apoplexy or pseudoapoplexy revealing a gonadotroph adenoma. A 69-year-old man, who had just started antiandrogen treatment (Gn-RH agonist) for prostatic cancer, was admitted to neurosurgery emergency because of increasing headache and visual impairment. The CT-scan disclosed the presence of a large pituitary mass with lateral invasion of the left cavernous sinus. Hormonel testing showed panhypopituitarism. A few days later, diabetes insipidus appeared. The patient first received corticosteroid therapy and underwent surgical adenomectomy. Immunostaining of the tumor tissue was positive for FSHbeta, confirming the diagnosis of gonadotroph adenoma. Three months after surgery, the endocrine evaluation showed pituitary insufficiency. An 81-year-old man complained of mnemonic disorders. The CT-scan revealed a pituitary mass without extension. The Ophthalmological examination showed left temporal upper quadranopsia. Endocrinological tests with administration of GN-HR triggered headache and vomiting. A second CT-scan was unchanged. Hormone testing revealed increased serum levels of FSH and decreased serum levels of LH. Surgical management of the primary tumor was undertaken due to the visual field alteration. Immunohistochemical studies confirmed the diagnosis of gonadotroph FSHbeta adenoma.
Hernandez Morin
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Service d'Endocrinologie et Métabolisme, Hôpital Saint-Joseph, 185, rue Raymond Losserand, 75014 Paris. nelly.morin@club-internet.fr
Huet
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D
Hautecouverture
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M
D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D005640:Follicle Stimulating Hormone / Q000097:blood; D037201:Follicle Stimulating Hormone, beta Subunit / Q000032:analysis; D007987:Gonadotropin-Releasing Hormone / Q000009:adverse effects* / Q000819:agonists / Q000627:therapeutic use; D006801:Humans; D016729:Leuprolide / Q000009:adverse effects*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D010899:Pituitary Apoplexy / Q000139:chemically induced*; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000601:surgery; D011471:Prostatic Neoplasms / Q000188:drug therapy; D014057:Tomography, X-Ray Computed
D037201:Follicle Stimulating Hormone, beta Subunit; D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D016729:Leuprolide