Endocrine Abstracts

Case: 60 year old transfemale had normal delivery, milestones and puberty. She developed gynaecomastia aged 14, associated obesity which resolved. As an adult she had reduced facial and body hair and reduced sexual function prior to hormone therapy but normal self-reported genitalia. She has female role from age of 24. She never had any children and was commenced female hormones 36 years ago. These were Premarin and Cyproterone Acetate which were continued post genital reconstructive surgery. No complications post operatively and her sexual function returned to normal. She had good breast development (c cup). She presented in early 2017 with rapid deteriorating visual acuity in the right eye. Investigations revealed three meningiomas – olfactory groove, left paraoptic, right sphenoid wing. All of these were Oestrogen receptor negative. She had neurosurgical intervention which confirmed no involvement of the pituitary gland. She had good improvement to vision. Post operatively Oestrogen and Cyproterone acetate was stopped. Post-operative pituitary profile off Oestrogen therapy confirmed

IGF-1 47.8 nmol/l

TSH 1.36 mU/l

Free T4 15.6 pmol/l

LH 18.4 IU/l

FSH 24.7 IU/l

Oestradiol <92 pmol/l

Testosterone 0.6 nmol/l

SHBG 84 nmol/l

Prolactin 151 mU/l

Discussion: There have been 11 cases reported in the literature of meningioma in transfemales using Oestrogen with Cyproterone acetate. All so far have been associated with long term cyproterone acetate use and either oestradiol, or ethinyl oestradiol use. This is the first report of a meningioma caused by long term premarin and cyproterone acetate. This case illustrates the importance of withdrawing antiandrogen therapy post genital surgery in transwomen. It also suggests the causative factor in meningioma formation is the cyproterone acetate not the oestrogen type used. Clinician should be aware of this as a possible complication of long term antiandrogen therapy in transfemales.