The GnRH test in the assessment of patients with pituitary and parapituitary lesions: results of a 5-year retrospective study

Chammas, Nida; Chambers, Susan M.; Harris, Philip E.

doi:10.1007/s11102-008-0124-4

Cited by 9 publications

(6 citation statements)

References 18 publications

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“…This finding is in sharp contrast to the high response rate (71%) we have recently observed in male hypogonadal patients with prolactinomas, treated with clomiphene using the same study protocol (15). Clomiphene failure to restore gonadal function in most patients with treated NFPA is likely to reflect a much lower functional reserve of gonadotrophic cells and/or GnRH neurons in these patients, as compared with prolactinoma patients (20). In fact, because of the poor efficacy of currently available medical treatment for NFPA, as opposed to the high efficacy of dopamine agonists in prolactinomas, NFPA patients are frequen- tly submitted to multiple surgeries and radiotherapy (1)(2)(3)(4)(5), increasing the risk of irreversible pituitary damage.…”

Section: Discussioncontrasting

confidence: 84%

Clomiphene fails to revert hypogonadism in most male patients with conventionally treated nonfunctioning pituitary adenomas

Ribeiro

Abucham

2011

Arq Bras Endocrinol Metab

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INTRODUCTIONC linically nonfunctioning pituitary adenomas (NFPA) are usually diagnosed due to compressive symptoms, most typically visual field abnormalities, headache and hypopituitarism. Hypogonadotropic hypogonadism in patients with NFPA is highly prevalent both at diagnosis and after conventional treatment with pituitary surgery and/or radiotherapy (1-5). Untreated hypogonadism decreases patient quality of life and fertility and increases cardiovascular risk (6-8).Male hypogonadal patients are usually treated with testosterone replacement, most often with intramusCopyright © ABE&M todos os direitos reservados. 267Arq Bras Endocrinol Metab. 2011;55/4 cular injections that require frequent applications and induce large fluctuations in serum testosterone levels, with corresponding fluctuations in patient energy, libido, sexual performance and mood. In addition, testosterone replacement has an inhibitory effect on spermatogenesis and fertility, which is undesirable in patients who want to have children (7,8).Clomiphene is a well-known selective estrogen receptor modulator that increases gonadotropin secretion via hypothalamic-pituitary action (9). Clomiphene has been extensively used in the evaluation of the gonadotropic axis and in the induction of ovulation. Clomiphene has also been shown to revert hypogonadotropic hypogonadism in several conditions, such as falciform anemia, uremia, alcohol and steroid abuse, and in the stimulation of gonadotropin secretion in patients with sulpiride-induced hyperprolactinemia and gonadotropin suppression (10-14). More recently, we have shown that clomiphene led to the recovery of gonadal function in most male patients with prolactinomas and persistent hypogonadism under dopamine agonist treatment, irrespective of prolactin levels (15). In this study, we evaluated the therapeutic potential of clomiphene in reverting hypogonadism in patients with conventionally treated NFPA. PATIENTS AND METHODS PatientsTwelve consecutive adult male patients with NFPA, previously treated with surgery with or without radiotherapy, seen during one year at the Neuroendocrine Unit of the Endocrinology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, presented hypogonadotropic hypogonadism and were considered to be included the protocol. Hypogonadotropic hypogonadism was defined by total testosterone levels below 300 ng/dL (10.5 nmol/L), and normal/low LH levels after at least two months of surgery. Testosterone replacement was discontinued for at least two months before evaluation. Three patients were excluded from the study due to prostate disease, limitations in schedule, or cognitive deficit. Nine patients completed the study. Study designThis study was an interventional, open label, uncontrolled, single-arm, prospective trial with oral clomiphene citrate (Clomid ® , Medley, kindly provided by Dr. Enrico Repetto), 50 mg/day for 12 weeks, designed to assess the effects of the drug on serum testosterone levels of male patients with NFPA previously treated with surgery. Th...

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Section: Discussioncontrasting

confidence: 84%

Clomiphene fails to revert hypogonadism in most male patients with conventionally treated nonfunctioning pituitary adenomas

Ribeiro

Abucham

2011

Arq Bras Endocrinol Metab

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“…This test was helpful to ascertain LH secretion status but not FSH secretion status, as described previously [23]. …”

Section: Discussionmentioning

confidence: 99%

Macroorchidism and Panhypopituitarism: Two Different Forms of Presentation of FSH-Secreting Pituitary Adenomas in Adolescence

Clemente

Caracseghi²,

Gussinyer³

et al. 2010

Horm Res Paediatr

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Background: FSH-secreting pituitary adenomas are extremely rare in children and are seldom associated with clinical manifestations of high serum gonadotrophin levels. Thus, most patients have a late presentation, usually as macroadenomas. Case Reports: Two different clinical forms of presentation of FSH-secreting pituitary adenomas are reported: one in a 12-year-old boy with macroorchidism due to a pituitary microadenoma, probably FSH-secreting, and the other in a 15-year-old boy with panhypopituitarism due to an FSH-producing macroadenoma. Both patients presented slightly high or high FSH with low LH and high inhibin B levels. In the first case, the microadenoma was treated medically with cabergoline, which failed to reduce FSH and inhibin B levels. No radiological progression has been observed despite increasing testicular volume. In the second case, surgery was performed on the macroadenoma, leading to a decrease in FSH and inhibin B levels. The patient developed severe hypothalamic obesity and is currently under treatment with somatostatin. Conclusions: FSH-secreting pituitary tumors have an extremely variable clinical expression. The discrepancy between normal or slightly increased FSH and low LH values, together with high inhibin B levels, strongly suggests FSH hypersecretion which should be studied.

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“…This test is neither sensitive nor specific for HH and positive response does not exclude nor ascertains pituitary or hypothalamic pathology, due to highly variable responses to GnRH stimulation [33,34]. Therefore, the clinical importance of this test to HH diagnosis seems to be obsolete, as it was previously reported [35].…”

Section: Nfpa Are Benign Intracranial Tumors With Potential Symptoms mentioning

confidence: 97%

Hypogonadotropic Hypogonadism in Non-Functioning Pituitary Adenomas: Impact of Intervention

Monteiro

Freitas

Vieira

et al. 2017

Exp Clin Endocrinol Diabetes

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To determine the prevalence of hypogonadotropic hypogonadism (HH) among patients with non-functioning pituitary adenomas (NFPA) and the post-surgery outcome on pituitary gonadotropins secretion (PGS); to determine the prevalence of erectile dysfunction (ED) on male patients with NFPA, to evaluate the impact of testosterone replacement therapy (TRT) in those with HH. Retrospective evaluation of gonadal function in 109 NFPA patients (45 males), with a mean age of 51.8 years, diagnosed on the last 10 years. ED questionnaire applied to 34 male patients. Male patients with NFPA were significantly older (males 58.1±15.8 vs. females 47.4±16.94; p=0.001). Most patients had macroadenomas (67%; p=0.001) and only a minority were incidentalomas (19%; p<0.001). Prevalence of HH was 40% (60% on males, 25% on females; p<0.001). Surgery was performed in 54% of all patients (71% of males, 42% of females; p<0.003). After intervention, 14% became HH, 69% maintained previous function and 17% improved. On the questionnaire, 76% reported having ED, 54% of which had HH and 21% were under TRT. Of the patients under TRT, 79% still had ED. Median age of patients with ED was significantly higher [with ED 65 vs. without 49 years; p=0.012). There was no BMI difference between patients with or without TRT (28.0 vs. 27.4 Kg/m). NFPA was more frequent in older rather than younger patients. Males were older, had more HH and surgery. There was no significant improvement of pituitary function with surgery (17%) and 13% became iatrogenic HH. TRT had a low efficacy to improve ED in these patients.

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The GnRH test in the assessment of patients with pituitary and parapituitary lesions: results of a 5-year retrospective study

Abstract: The data from this study indicate that the GnRH test is unhelpful in the clinical assessment of the HP axis in patients with HP disease.

Cited by 9 publications

References 18 publications

Clomiphene fails to revert hypogonadism in most male patients with conventionally treated nonfunctioning pituitary adenomas

Clomiphene fails to revert hypogonadism in most male patients with conventionally treated nonfunctioning pituitary adenomas

Macroorchidism and Panhypopituitarism: Two Different Forms of Presentation of FSH-Secreting Pituitary Adenomas in Adolescence

Hypogonadotropic Hypogonadism in Non-Functioning Pituitary Adenomas: Impact of Intervention

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