Gonadotroph adenoma of the pituitary gland: A clinicopathologic analysis of 100 cases

William Francis Young, B. W. Scheithauer, K. T. Kovacs, E. Horvath, D. H. Davis, R. V. Randall

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Abstract

Objective: To determine the clinical and pathologic features in a large cohort of randomly selected patients with gonadotroph pituitary adenomas. Design: We retrospectively reviewed clinical, surgical, and pathologic findings in 100 patients (79 men and 21 women, 30 to 82 years old) with this tumor. Results: Diagnosis of a pituitary tumor was prompted by visual loss (43%), symptoms of hypopituitarism (22%), headache (8%), or a combination of these findings (10%); 17% of the patients were asymptomatic. Visual field defects were present in 68% of the study group, and complete or partial anterior pituitary failure was present in 77%. Serum prolactin concentrations were increased (maximum, 110 ng/mL) in 33% of patients. Hypersecretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was documented in 11 and 5 patients, respectively. The serum level of α-subunit was increased in 1 of 29 patients in whom it was measured. All patients had pituitary macroadenomas, only 21% of which were grossly invasive. The surgical approach was transsphenoidal in all but two patients, who underwent transfrontal craniotomy; gross total tumor resection was achieved in 90%. By definition, all tumors had at least 10% immunoreactivity for LH, FSH, or both. All tumors were chromophobic. Ultrastructurally, the tumors were characterized as gonadotroph adenomas of 'male' (45%) or 'female' (9%) type as well as null-cell adenomas of the oncocytic (35%) or nononcocytic (11%) type. After a median follow-up of 4.3 years, 69% of the patients who had had visual field defects noted normalization or improvement. Persistent or clinically recurrent pituitary tumor tissue was present in 42%. A second pituitary surgical procedure was required in eight patients. Conclusion: Most patients with clinically evident gonadotroph pituitary tumors have loss of vision and hypopituitarism. Hypersecretion of FSH or LH is unusual, and no distinct hormone-dependent clinical phenotype is present. Transsphenoidal surgical treatment generally yields normalization or improvement of visual field defects.

Original languageEnglish (US)
Pages (from-to)649-656
Number of pages8
JournalMayo Clinic Proceedings
Volume71
Issue number7
StatePublished - 1996

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Gonadotrophs
Pituitary Gland
Adenoma
Pituitary Neoplasms
Follicle Stimulating Hormone
Luteinizing Hormone
Visual Fields
Hypopituitarism
Neoplasms
Null Lymphocytes
Craniotomy
Serum
Prolactin
Headache

ASJC Scopus subject areas

  • Medicine(all)

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Young, W. F., Scheithauer, B. W., Kovacs, K. T., Horvath, E., Davis, D. H., & Randall, R. V. (1996). Gonadotroph adenoma of the pituitary gland: A clinicopathologic analysis of 100 cases. Mayo Clinic Proceedings, 71(7), 649-656.

Gonadotroph adenoma of the pituitary gland : A clinicopathologic analysis of 100 cases. / Young, William Francis; Scheithauer, B. W.; Kovacs, K. T.; Horvath, E.; Davis, D. H.; Randall, R. V.

In: Mayo Clinic Proceedings, Vol. 71, No. 7, 1996, p. 649-656.

Research output: Contribution to journalArticle

Young, WF, Scheithauer, BW, Kovacs, KT, Horvath, E, Davis, DH & Randall, RV 1996, 'Gonadotroph adenoma of the pituitary gland: A clinicopathologic analysis of 100 cases', Mayo Clinic Proceedings, vol. 71, no. 7, pp. 649-656.
Young WF, Scheithauer BW, Kovacs KT, Horvath E, Davis DH, Randall RV. Gonadotroph adenoma of the pituitary gland: A clinicopathologic analysis of 100 cases. Mayo Clinic Proceedings. 1996;71(7):649-656.
Young, William Francis ; Scheithauer, B. W. ; Kovacs, K. T. ; Horvath, E. ; Davis, D. H. ; Randall, R. V. / Gonadotroph adenoma of the pituitary gland : A clinicopathologic analysis of 100 cases. In: Mayo Clinic Proceedings. 1996 ; Vol. 71, No. 7. pp. 649-656.
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abstract = "Objective: To determine the clinical and pathologic features in a large cohort of randomly selected patients with gonadotroph pituitary adenomas. Design: We retrospectively reviewed clinical, surgical, and pathologic findings in 100 patients (79 men and 21 women, 30 to 82 years old) with this tumor. Results: Diagnosis of a pituitary tumor was prompted by visual loss (43{\%}), symptoms of hypopituitarism (22{\%}), headache (8{\%}), or a combination of these findings (10{\%}); 17{\%} of the patients were asymptomatic. Visual field defects were present in 68{\%} of the study group, and complete or partial anterior pituitary failure was present in 77{\%}. Serum prolactin concentrations were increased (maximum, 110 ng/mL) in 33{\%} of patients. Hypersecretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was documented in 11 and 5 patients, respectively. The serum level of α-subunit was increased in 1 of 29 patients in whom it was measured. All patients had pituitary macroadenomas, only 21{\%} of which were grossly invasive. The surgical approach was transsphenoidal in all but two patients, who underwent transfrontal craniotomy; gross total tumor resection was achieved in 90{\%}. By definition, all tumors had at least 10{\%} immunoreactivity for LH, FSH, or both. All tumors were chromophobic. Ultrastructurally, the tumors were characterized as gonadotroph adenomas of 'male' (45{\%}) or 'female' (9{\%}) type as well as null-cell adenomas of the oncocytic (35{\%}) or nononcocytic (11{\%}) type. After a median follow-up of 4.3 years, 69{\%} of the patients who had had visual field defects noted normalization or improvement. Persistent or clinically recurrent pituitary tumor tissue was present in 42{\%}. A second pituitary surgical procedure was required in eight patients. Conclusion: Most patients with clinically evident gonadotroph pituitary tumors have loss of vision and hypopituitarism. Hypersecretion of FSH or LH is unusual, and no distinct hormone-dependent clinical phenotype is present. Transsphenoidal surgical treatment generally yields normalization or improvement of visual field defects.",
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T2 - A clinicopathologic analysis of 100 cases

AU - Young, William Francis

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AU - Kovacs, K. T.

AU - Horvath, E.

AU - Davis, D. H.

AU - Randall, R. V.

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N2 - Objective: To determine the clinical and pathologic features in a large cohort of randomly selected patients with gonadotroph pituitary adenomas. Design: We retrospectively reviewed clinical, surgical, and pathologic findings in 100 patients (79 men and 21 women, 30 to 82 years old) with this tumor. Results: Diagnosis of a pituitary tumor was prompted by visual loss (43%), symptoms of hypopituitarism (22%), headache (8%), or a combination of these findings (10%); 17% of the patients were asymptomatic. Visual field defects were present in 68% of the study group, and complete or partial anterior pituitary failure was present in 77%. Serum prolactin concentrations were increased (maximum, 110 ng/mL) in 33% of patients. Hypersecretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was documented in 11 and 5 patients, respectively. The serum level of α-subunit was increased in 1 of 29 patients in whom it was measured. All patients had pituitary macroadenomas, only 21% of which were grossly invasive. The surgical approach was transsphenoidal in all but two patients, who underwent transfrontal craniotomy; gross total tumor resection was achieved in 90%. By definition, all tumors had at least 10% immunoreactivity for LH, FSH, or both. All tumors were chromophobic. Ultrastructurally, the tumors were characterized as gonadotroph adenomas of 'male' (45%) or 'female' (9%) type as well as null-cell adenomas of the oncocytic (35%) or nononcocytic (11%) type. After a median follow-up of 4.3 years, 69% of the patients who had had visual field defects noted normalization or improvement. Persistent or clinically recurrent pituitary tumor tissue was present in 42%. A second pituitary surgical procedure was required in eight patients. Conclusion: Most patients with clinically evident gonadotroph pituitary tumors have loss of vision and hypopituitarism. Hypersecretion of FSH or LH is unusual, and no distinct hormone-dependent clinical phenotype is present. Transsphenoidal surgical treatment generally yields normalization or improvement of visual field defects.

AB - Objective: To determine the clinical and pathologic features in a large cohort of randomly selected patients with gonadotroph pituitary adenomas. Design: We retrospectively reviewed clinical, surgical, and pathologic findings in 100 patients (79 men and 21 women, 30 to 82 years old) with this tumor. Results: Diagnosis of a pituitary tumor was prompted by visual loss (43%), symptoms of hypopituitarism (22%), headache (8%), or a combination of these findings (10%); 17% of the patients were asymptomatic. Visual field defects were present in 68% of the study group, and complete or partial anterior pituitary failure was present in 77%. Serum prolactin concentrations were increased (maximum, 110 ng/mL) in 33% of patients. Hypersecretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was documented in 11 and 5 patients, respectively. The serum level of α-subunit was increased in 1 of 29 patients in whom it was measured. All patients had pituitary macroadenomas, only 21% of which were grossly invasive. The surgical approach was transsphenoidal in all but two patients, who underwent transfrontal craniotomy; gross total tumor resection was achieved in 90%. By definition, all tumors had at least 10% immunoreactivity for LH, FSH, or both. All tumors were chromophobic. Ultrastructurally, the tumors were characterized as gonadotroph adenomas of 'male' (45%) or 'female' (9%) type as well as null-cell adenomas of the oncocytic (35%) or nononcocytic (11%) type. After a median follow-up of 4.3 years, 69% of the patients who had had visual field defects noted normalization or improvement. Persistent or clinically recurrent pituitary tumor tissue was present in 42%. A second pituitary surgical procedure was required in eight patients. Conclusion: Most patients with clinically evident gonadotroph pituitary tumors have loss of vision and hypopituitarism. Hypersecretion of FSH or LH is unusual, and no distinct hormone-dependent clinical phenotype is present. Transsphenoidal surgical treatment generally yields normalization or improvement of visual field defects.

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