一名患有分泌 FSH 垂体大腺瘤的男性,尽管睾酮水平正常,但性欲低下。

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Randa Ghazal Asswad, Muhammad Ilyas Khan, Catherine Elizabeth Gilkes, Christina Daousi, Sravan Kumar Thondam
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引用次数: 0

摘要

摘要有临床表现的功能性促性腺激素腺瘤极为罕见,其中大多数是分泌 FSH 的大腺瘤。临床症状是由于促性腺激素和性激素过多引起的,这些症状可能在垂体腺瘤确诊前已存在很长时间。我们报告的病例是一名 37 岁的白种男性,临床表现为分泌 FSH 的垂体大腺瘤。他有一年的性功能障碍,随后出现双侧睾丸疼痛和肿大,起初被当作疑似复发性附睾炎治疗,但症状并未缓解。一年后,他出现头痛和双侧颞上视野缺损。脑成像证实他患有脑垂体大腺瘤,视交叉受压。垂体图谱显示,FSH异常高,LH正常,睾酮水平正常。患者成功接受了经蝶下叶切除术,组织学检查证实了促性腺激素分化和以FSH为主的免疫反应。术后促性腺激素水平和睾酮显著下降,他开始接受睾酮替代治疗。术后两年的磁共振成像显示垂体腺瘤没有复发。总之,睾丸增大和伴有低睾酮水平的性腺功能减退症状是分泌 FSH 的垂体腺瘤的公认特征。我们的患者在手术前有性腺功能减退症状,但睾酮水平一直很高。睾酮水平高但性欲低下的原因尚不清楚。我们的病例强调,在处理性腺功能减退症状、睾丸增大、睾酮水平低或正常的不寻常组合时,需要怀疑这种罕见的潜在垂体病变:分泌过多促卵泡激素(FSH)的功能性垂体腺瘤非常罕见,通常会出现与垂体肿块效应相关的症状。睾丸肿大和性功能障碍是男性患者常出现的症状。垂体病理检查结果显示,FSH水平升高,而睾酮水平较低、正常甚至偏高,但这并不一定与临床症状相关。如果男性出现异常的睾丸增大和性腺功能减退症状,即使睾酮水平正常,也应考虑垂体病变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Low libido despite high normal testosterone levels in a male with an FSH-secreting pituitary macroadenoma.

Summary: Functioning gonadotroph adenomas with clinical manifestations are extremely rare and the majority of these are FSH-secreting macroadenomas. Clinical symptoms are due to excess gonadotrophins and sex hormones, and these may be present for a long time before the diagnosis of pituitary adenoma is made. We present the case of a 37-year-old Caucasian male with clinical manifestations of an FSH-secreting pituitary macroadenoma. He had sexual dysfunction for a year followed by bilateral testicular pain and enlargement which was initially treated as suspected recurrent epididymitis, but his symptoms did not resolve. He presented a year later with headaches and bilateral superior temporal visual field defects. Brain imaging confirmed a pituitary macroadenoma with optic chiasm compression. Pituitary profile demonstrated an unusually high FSH with high normal LH and normal testosterone level. The patient successfully underwent transsphenoidal hypophysectomy and histology confirmed gonadotroph differentiation and immunoreactivity predominantly with FSH. Gonadotrophin levels and testosterone dropped significantly after surgery, and he was started on testosterone replacement. MR imaging, 2 years post surgery, showed no recurrence of pituitary adenoma. In conclusion, testicular enlargement and hypogonadal symptoms associated with low testosterone levels are recognised features in FSH-secreting pituitary adenomas. Our patient had hypogonadal symptoms but consistently high normal testosterone levels prior to surgery. The reason for low libido despite high testosterone is unclear. Our case highlights the need to suspect such rare underlying pituitary pathology when dealing with unusual combinations of hypogonadal symptoms, testicular enlargement with low or normal testosterone levels.

Learning points: Functioning pituitary adenomas that secrete excess follicle-stimulating hormone (FSH) are very rare and often present with symptoms related to pituitary mass effect. Testicular enlargement alongside sexual dysfunction are commonly reported symptoms amongst male patients. Pituitary profile results demonstrate a raised FSH level with either a low, normal, or even high testosterone level which may not always correlate to clinical symptoms. Pituitary pathology should be considered in males presenting with unusual combinations of testicular enlargement and hypogonadal symptoms even with normal testosterone levels.

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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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