Gonadotrofinomas: análisis multicéntrico y retrospectivo de 66 pacientes

the aim of our study was to describe the clinical-biochemical and radiologic presentation and the post surgery outcome in a cohort of patients with gonadotrophinomas. patients were selected from nine endocrinology units of the city of buenos aires from 1983 at 2003. the inclusion criteria was defined by nonfunctinoning pituitary adenomas with positive innmunohistochemical (ih) for luteinizing hormone (lh), follicle-stimulating hormone (fsh) and/or alpha subunit (asu). innmunohistochemically plurihormonal adenomas were excluded. sixty six patients were analyzed, aged 51,8 ± 12,1 (x +/- ds) years; (39 men). more prevalent symptoms were visual alterations (72,8%), hypogonadism and headaches. eleven percent was diagnosed as incidentalomas. ninety eight percent were macroadenomas, 56,9% was hardy stage (hs) 3 and 29,6% was hs 4. the patients were followed up for 47,8 months (r: 5-168). hypogonadism was biochemically found in 82,4%. the majority showed low or inappropriately normal levels of gonadotrophins except for 4 women and 3 men that had high and dissociated levels. hyperprolactinemia was observed in 45,2% and was interpreted as an interference with normal dopamine inhibition of prolactin secretion (x+/-ds: 65.6+/- ng/ml, r: 30-172). hypopituitarism was found in 25,7% of the patients. transsphenoidal surgery was carried out in 80% and in 28% a second surgery was needed. the ih was positive for lh, fsh and asu in this order of frequency or its combinations. tumor persistency and/or recurrency were found in 84% of the patients. forty one percent showed improvement of visual defects. radiotherapy was indicated in 37% and hormonal replacement was needed in 65% of the patients.