Gonadal Function in Fifty Men with Untreated Pituitary Adenomas*

Snyder, Peter J.; Bigdeli, Homayoon; Gardner, David F.; Mihailovic, Vesna; Rudenstein, Robert S.; Sterling, Francis H.; Utiger, Robert D.

doi:10.1210/jcem-48-2-309

Cited by 48 publications

(8 citation statements)

References 18 publications

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“…This is in agreement with previous findings of normal or slightly low LH levels (Thorner et al 1977;Carter et al 1978;Franks et al 1978;Snyder et al 1979;Ambrosi et al 1981) and of abnormal LH pulsatility in men with prolac¬ tinomas (Silverman et al 1978;Winters & Troen 1982). Although an increase in mean LH concen¬ tration and frequency of pulses has been noted after Prl normalization in hyperprolactinaemic padents (Bohnet et al 1976;Winters & Troen 1982;Moult et al 1982), we did not find any difference in LH pulsatility in the patients with different degree of hyperprolactinaemia nor in the 7 patients studied before and after Prl normalization.…”

Section: Discussionsupporting

confidence: 93%

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Serum gonadotrophin pulsatile secretion in men with Prl-secreting and non-secreting pituitary tumours

Ambrosi¹,

Giovine²,

Nava³

et al. 1985

Acta Endocrinologica

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In order to investigate the possible influence of prolactin (Prl) at the hypothalamic level, serum LH and FSH pulsatility was studied in 16 male patients with prolactinomas, normally LH responders to GnRH (group A): 8 of them were untreated (group A1) and 8 had undergone previous unsuccessful pituitary treatments (group A2). In 7 patients the study was repeated when serum Prl was normalized by bromocriptine treatment (group B). For comparison the secretory pattern of LH and FSH was studied in 6 male patients with non\x=req-\ secreting pituitary tumours (group C). All parameters of LH pulsatile secretion (i.e. arithmetic mean of the single concentration, coefficient of variation from the mean value, frequency of peaks, amplitude of pulses expressed as either absolute or per cent value) were significantly lower in patients of groups A1, A2 and C than in normal subjects and no difference was found between the three groups. Furthermore the 7 patients with prolactinomas studied both before and after bromocriptine-induced Prl normalization showed no difference in all the parameters of LH pulsatility in both conditions. No significant abnormalities of FSH secretory pattern were found in the patients of groups A1, A2, B and C in comparison to normal subjects. In all groups of patients mean serum testosterone basal levels were significantly lower than in normals, while the mean oestradiol-17\g=b\ basal concentration was normal. The abnormalities in LH pulsatility found in untreated and bromocriptine-treated patients with prolactinomas and in patients with non-secreting tumours indicate an impairment of GnRH release in such patients; these findings suggest that Prl excess is not the only cause of the abnormalities in LH pulsatile secretion.

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Section: Discussionsupporting

confidence: 93%

“…However, the mechanisms by which hyperprolac¬ tinaemia induces hypogonadism in males are still controversial. An impairment at the hypothalamicpituitary level is indicated by the inadequate serum LH rise in presence of low testosterone levels (Franks et al 1978;Snyder et al 1979); suggesting an alteration of H-P-T feedback mechanisms.…”

mentioning

confidence: 99%

Serum gonadotrophin pulsatile secretion in men with Prl-secreting and non-secreting pituitary tumours

Ambrosi¹,

Giovine²,

Nava³

et al. 1985

Acta Endocrinologica

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“…Although human pituitary tumours due to, or associated with, gonadotrophin hypersecretion are rare, authors of previously reported cases have also commented on the low frequency of LH hypersecretion in such patients (Woolf & Schenk, 1974;Cunningham & Huckins, 1977;Snyder et al, 1979Snyder et al, , 1980Wide & Lundberg, 1981) although both LH and FSH are presumed to be secreted by one cell type (Phifer et a/., 1973;Robyner al., 1973;Herbert, 1976). Wide & Lundberg (1981) found an unusual form of FSH in the serum of their female patient with a pituitary tumour and FSH hypersecretion, and suggested this abnormal form of tumour FSH could suppress normal FSH and LH secretion.…”

Section: Discussionmentioning

confidence: 99%

Gonadotrophin and Alpha Subunit Secretion by Human ‘Functionless’ Pituitary Adenomas in Cell Culture: Long Term Effects of Luteinizing Hormone Releasing Hormone and Thyrotrophin Releasing Hormone

Surmont

Winslow

Loizou

et al. 1983

Clinical Endocrinology

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The long-term effects of LHRH and TRH on gonadotrophin alpha subunit, FSH and LH secretion by cell cultures of four human chromophobic pituitary tumours have been examined. The tumours derived from one male and three female patients who presented because of visual disturbance but had no evident endocrine symptoms. Subsequent serum hormone analysis showed the FSH to be high in the male but low or normal in the post-menopausal females whereas LH levels were low in all patients. In culture, basal hormone secretion could be maintained for periods up to 63 d. All tumours secreted alpha subunit and FSH, but much lower amounts of LH. Addition of LHRH or TRH for a period of 12 to 41 d showed that alpha subunit, FSH and LH secretion were stimulated by LHRH from one tumour, by LHRH and TRH from two tumours. There was always a rapid decline in the LH secretion. The tumour which secreted FSH predominantly was stimulated by TRH. We conclude that human pituitary 'functionless' adenomas can secrete gonadotrophin alpha subunit and FSH in vitro and that secretion can be stimulated during long term releasing hormone experiments. LH secretion, however, cannot be maintained.

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“…Macroadenomas often cause an initial loss of growth hormone, follicle-stimulating hormone, and luteinizing hormone, followed by reduction of TSH and ACTH, and lastly, if at all, prolactin. [11][12][13][14] In contrast, LH frequently results in isolated ACTH deficiency or combined adrenal/thyroid deficiencies despite normal gonadal function. 15,16 Specific pituicytes appear to be more susceptible to cellular destruction with ACTH-producing cells most frequently affected and gonadotrophs most commonly spared.…”

Section: Discussionmentioning

confidence: 99%

Lymphocytic Hypophysitis With Subsequent Development of Graves Disease

Sonnier¹,

Osterman²,

Dubuisson³

et al. 2006

The Endocrinologist

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Lymphocytic hypophysitis (LH), a rare pituitary condition mimicking pituitary macroadenoma, presents most commonly in the peripartum period. This presumably autoimmune disease can occur as an isolated entity or be associated with other autoimmune conditions. The association of LH with Graves disease is extremely rare. We present the clinical course and laboratory evaluation of a woman who developed LH in the third trimester of her fifth pregnancy. The patient then developed overt Graves disease 2 years later. A 21-year-old black woman with an unremarkable medical and obstetric history developed severe headache and partial visual loss during the third trimester of her fifth pregnancy. Evaluation revealed a large partially hemorrhagic pituitary mass with suprasellar extension compressing the optic chiasm. Pathologic evaluation after transsphenoidal surgery confirmed the resected mass to be lymphocytic hypophysitis. Postoperative evaluation documented persistent panhypopituitarism and central diabetes insipidus. She remained clinically stable for 2 years receiving physiological doses of glucocorticoid, levothyroxine, and desmopressin. She then developed symptoms and signs of hyperthyroidism. Levothyroxine was discontinued and additional evaluation was consistent with Graves disease. Patients with severe headache and visual difficulties during pregnancy or the postpartum period should have a detailed neurologic and endocrinologic evaluation. Lymphocytic hypophysitis, a rare pituitary condition, should be considered in the differential diagnosis. It is important to keep close clinical follow up of such patients because they may develop other autoimmune diseases as illustrated by the present case report. (The Endocrinologist 2006;16: 223-226) Learning Objectives• Recall what is known about the demographic and presenting clinical and radiologic features of lymphocytic hypophysitis (LH) as well as its immunologic aspects. • Summarize the hormonal abnormalities found in the present patient and previously reported patients with LH, emphasizing those that make it possible to distinguish between LH and pituitary macroadenoma. • Compare the various treatment options available for patients with LH and the circumstances under which each may be appropriate.L ymphocytic hypophysitis (LH), an uncommon clinical entity, was first described at an autopsy case in 1962. 1 Since then, more than 125 cases of LH have been reported. 2 The majority of patients (approximately 70%) have been young women presenting during pregnancy or in the postpartum period. Approximately 15% of reported patients were men. 2,3 Histologically, LH is characterized by diffuse infiltration of the pituitary by lymphocytes and plasma cells and varying degrees of pituicyte destruction. LH may present as an isolated disorder or be associated with other autoimmune diseases. 2,4,5 LH is thought to have an autoimmune etiology, and the frequent association of LH with pregnancy may be possibly the result of increased exposure to pituitary antigens or changes in maternal ...

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Gonadal Function in Fifty Men with Untreated Pituitary Adenomas*

Cited by 48 publications

References 18 publications

Serum gonadotrophin pulsatile secretion in men with Prl-secreting and non-secreting pituitary tumours

Serum gonadotrophin pulsatile secretion in men with Prl-secreting and non-secreting pituitary tumours

Gonadotrophin and Alpha Subunit Secretion by Human ‘Functionless’ Pituitary Adenomas in Cell Culture: Long Term Effects of Luteinizing Hormone Releasing Hormone and Thyrotrophin Releasing Hormone

Lymphocytic Hypophysitis With Subsequent Development of Graves Disease

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