Endocrine Abstracts

Objective: To report a case of hypogonadism reversal and spontaneous puberty in a craniopharyngioma patient who suffered from hypopituitarism as a result of complete surgical resection.

Methods: A 13-year-old boy with hypopituitarism was evaluated for right testicular sensitivity.

At the age of 6 the child presented with growth arrest and a craniopharyngioma causing pituitary insufficiency was diagnosed. Treatment with hydrocortisnone and thyroxine supplementation was initiated and he was subjected to a transphenoidal surgery that resulted in complete tumor resection (adamantinoma). Postsurgical biochemical testing confirmed panhypopituitarism and he was prescribed levothyroxine, hydrocortisone and desmopressin supplementation. Recombinant growth hormone was initiated 2 years later since growth had not resumed. Gonadotropins had been undetectable since diagnosis and the last evaluation had confirmed prepubertal status.

On clinical examination increased testicular volume was found (10–12 ml) with absence of pubic hair and mild sensitivity was confirmed. The Scrotum ultrasound revealed normal appearing testes with a maximal diameter of 4.5 cm left and 4.1 cm right. Testosterone and adrenal androgen levels were below normal limits but a GnRH stimulation test (2.5 μ/kg) provoked a four fold increase of LH. Onset of puberty was suspected.

Results: Six months later, measurement of basal gonadotropins (FSH=1.4 U/L, LH=1.8 U/L), testosterone (98 ng/dl NL 10–572) and inhibin B (216 pg/ml NL 68–300) indicated the onset of puberty that was confirmed by a tenfold increase of LH in the GnRH stimulation test.

Conclusions: Recovery of pituitary function in craniopharyngioma patients who had panhypopituitarism both prior and after complete surgical resection of the tumor has only rarely been reported. Nevertheless, this case depicts that one should consider the possibility of a functional gonadal axis prior to steroid supplementation for puberty induction to children suffering from hypopituitarism due to craniopharyngioma diagnosed and treated before the onset of puberty.