ACTA ENDOCRINOLOGICA (BUC)

Objective. To assess the outcome of clinical and endocrinological dysfunctions after transsphenoidal decompression in parasellar meningioma. Methods. Retrospective pre- and postoperative evaluation of 40 patients (30 women, 10 men; mean age, 55.9±11.9) who underwent decompressive transsphenoidal microsurgeries. The preoperative investigation took place one month prior surgery, the first follow-up within one week, the second follow-up within three months postoperatively. Results. The most common symptom in our study was diplopia (47.5%, n=19) which showed improvement in 21.1% (n=4) of cases. Preoperative hyperprolactinemia, presented in 52.5% of patients (n=21) with hyperprolactinemia remaining in just 20% of patients (n=8) in the first follow-up. Other endocrine axes were affected less frequently, but also majorly showed improvements. The corticotropic axis was affected in 8.8% (n=3) and remained unchanged. Female gonadotropic axis irritation decreased from 34.5% (n=10) to 31.0% (n=9), male axis deterioration improved in two cases from 50% (n=5) to 30% (n=3). The somatotropic and thyrotropic axes were never negatively affected. Adjuvant radiotherapy was carried out in 60% (n=24) of patients and not yet commenced in an additional nine (22.5%). Conclusion. Experience shows that transsphenoidal decompression is a useful and low complication associated procedure in the initial management of cavernous sinus meningioma.

Prolonged target gland failure causes pituitary hyperplasia, but rarely, secondary hyperplasias develop into autonomous neoplasms. We report herein a rare example of gonadotroph adenoma arising in a patient with prolonged hypogonadism due to Klinefelter syndrome. A pituitary macroadenoma with suprasellar extension was discovered incidentally by magnetic resonance imaging (MRI), in search for the cause of chronic saliva retention. His pre-operative serum concentrations of both luteinizing hormone (LH) and mostly follicle-stimulating hormone (FSH) were distinctly higher than normal, as expected, but the levels decreased after complete removal of the tumor, suggesting partial secretion of gonadotropins by the tumor. The surgically removed tissue showed a typical pituitary adenoma with distinct immunoreactivity for FSH (intense, homogeneous) and LH (scattered). In the fragmented parts of adjacent gland tissue, no hormone producing cell hyperplasia or presence of gonadal deficiency cells were detectable. In conclusion, our case is the description of a rare example of gonadotropin producing pituitary adenoma (FSH and LH) with increased serum levels of both gonadotropins in a patient with untreated Klinefelter syndrome.