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Functional Gonadotroph Pituitary Adenomas: Clinical Presentation and Management

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Pituitary Disorders throughout the Life Cycle

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Abstract

Although tumors of gonadotroph lineage comprise a significant proportion of pituitary adenomas, functional gonadotroph adenomas that secrete biologically active FSH and/or LH are rare. The clinical manifestations of non-functioning tumors often are delayed unless there are mass effect symptoms and signs, while functional gonadotroph tumors may come to medical attention due to the impact on the reproductive axis and fertility. In females, functional FSH-secreting tumors can lead to a presentation that mimics polycystic ovary syndrome, and in extreme cases, ovarian hyperstimulation has been reported. In males, functional gonadotroph adenomas also can cause changes in reproductive health, such as with macro-orchidism from a FSH-secreting tumor or supraphysiologic levels of testosterone with tumoral LH secretion. There are no proven and effective pharmacotherapies to treat these tumors, and surgical resection is the first line of treatment to ameliorate the effects of the elevated gonadotropins.

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Abbreviations

FSH:

Follicle-stimulating hormone

GnRH:

Gonadotropin-releasing hormone

HCG:

Human chorionic gonadotropin

LH:

Luteinizing hormone

NFPA:

Non-functioning pituitary adenoma

PCOS:

Polycystic ovary syndrome

SF-1:

Steroidogenic factor 1

TSH:

Thyroid-stimulating hormone

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  1. Mayo Clinic, Jacksonville, FL, USA

    Susan L. Samson

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Correspondence to Susan L. Samson .

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  1. Mayo Clinic, Jacksonville, FL, USA

    Susan L. Samson

  2. Emory University School of Medicine, Atlanta, GA, USA

    Adriana G. Ioachimescu

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Samson, S.L. (2022). Functional Gonadotroph Pituitary Adenomas: Clinical Presentation and Management. In: Samson, S.L., Ioachimescu, A.G. (eds) Pituitary Disorders throughout the Life Cycle. Springer, Cham. https://doi.org/10.1007/978-3-030-99918-6_11

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  • DOI: https://doi.org/10.1007/978-3-030-99918-6_11

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