A Silent Follicle-Stimulating Hormone-Producing Pituitary Adenoma in a Teenage Male
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A Silent Follicle-Stimulating Hormone-Producing Pituitary Adenoma in a Teenage Male Hiroyuki Tamiya & Noriaki Fukuhara & Naohiro Yoshida & Hisanori Suzuki & Akira Takeshita & Naoko Inoshita & Hiroshi Nishioka & Yasuhiro Takeuchi & Toshiaki Sano & Shozo Yamada
Published online: 19 August 2011 # Springer Science+Business Media, LLC 2011
Abstract An 18-year-old male was referred to Toranomon Hospital seeking reoperation for recurrent clinically nonfunctioning pituitary adenoma. A pituitary macroadenoma was first suspected at age 15 due to intractable headaches. Endocrine data were unremarkable except slightly elevated serum follicle-stimulating hormone (FSH). Transsphenoidal surgery done at another hospital achieved partial tumor removal but the remaining tumor regrew 2 years after surgery. The recurrent tumor was completely and selectively removed on repeat surgery at Toranomon Hospital. Pathological examination confirmed a silent FSH-producing pituitary adenoma. Fortyfive patients less than 20 years old underwent transsphenoidal surgery for pituitary adenoma at Toranomon Hospital between 1993 and 2010. Of the 45 patients, 36 (80.0%) had clinically functioning adenomas and the other 9 (20.0%) had clinically non-functioning adenomas. No patients, other than the present case, had a silent gonadotroph adenoma. In contrast, among 579 patients over 20 years old undergoing surgery for nonfunctioning pituitary adenomas between 2006 and 2010 at Toranomon Hospital, 304 (52.3%) had silent gonadotroph adenomas. Gonadotroph adenomas are more common with H. Tamiya (*) : N. Yoshida : H. Suzuki : A. Takeshita : Y. Takeuchi Department of Endocrinology, Toranomon Hospital, Toranomon 2-2-2, Minato, Tokyo 105-8470, Japan e-mail: [email protected] N. Fukuhara : H. Nishioka : S. Yamada Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Toranomon 2-2-2, Minato, Tokyo 105-8470, Japan N. Inoshita : T. Sano Department of Pathology, Toranomon Hospital, Toranomon 2-2-2, Minato, Tokyo 105-8470, Japan
aging: for example, 37 (61.7%) of 60 patients more than 70 years old at the time of operation had gonadotroph adenomas. In conclusion, gonadotroph adenomas, especially silent gonadotroph adenomas, are extremely rare in childhood and adolescence. Keywords Gonadotroph adenoma . Nonfunctioning pituitary adenoma . Follicle-stimulating hormone . Pituitary adenoma in childhood or adolescence
Introduction Approximately 20–30% of surgically removed pituitary adenomas are clinically silent; that is, without clinical evidence of increased release of any known pituitary hormones [1, 2]. Although they are the most frequent morphology type among all ages, gonadotroph adenomas are considered rare in childhood and adolescence [3–8]. On pathological analysis of 118 gonadotroph adenomas, only one patient, an 18-year-old female, was under 20 [4]. In another analysis, only one case of gonadotroph adenoma was found among 36 cases of pituitary tumors in patients less than 17 years old [5]. We report a case of a silent gonadotroph adenoma in a tee
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