Endocrine Abstracts

Context: Pituitary tumor can cause infertility. It can be hormonally active adenoma (mostly prolactinoma) or hormonally inactive. Hyperprolactinemia is the most common disorder. Prolactin interferes with pulsatile secretion of the hypothalamus gonadoliberin (GnRH) and consequent pituitary gonadotropins (FSH and LH), and then leads to abnormal gonadal function. As a result, a man gets impaired spermatogenesis and endocrine function of the testicles. Infertility and reduced testosterone secretion occurs.

Objective: We present a case report of a 33-year-old man. For 5 years, a couple have been diagnosed due to unexplained infertility. The reason for infertility was seen in a woman who underwent many different therapies. Because of the intensifying visual disturbances and headaches, the man came to the ophthalmologist. Based on the fundus examination, the brain tumor was suspected. Head tumor was confirmed through the head MRI. The reason for the infertility of the couple turned out to be a male pituitary tumor growing for many years.

Methods: The MRI describes a 3 cm pituitary tumor with pressure on the intersection of optic nerves. Hormonal studies showed hyperprolactinemia and hypogonadotropic hypogonadism. Due to the lack of erection it was impossible to perform a semen analysis. Diagnosis was established: inactive pituitary macroadenoma. A successful craniotomy operation was performed, removing the major part of the tumor, thus saving the patient’s sight and life. After removal of the tumor (and damaged pituitary gland) eyesight improved, but multi-hormonal hypopituitarism occurred. However, it was not the biggest problem for our patient. The most difficult was to accept infertility.

Intervention: Due to the efforts to conceive a child, testosterone was discontinued and the treatment of gonadotropin started. FSH and LH were administered. FSH at a dose of 75 units 2 times a week and LH at a dose of 2500 units two times a week. Substitution with hydrocortisone, levothyroxine and vasopressin analogue continued.

Result: The therapy turned out to be extremely effective, after less than five months of treatment with gonadotropins, the woman became pregnant.

Conclusions: Pituitary tumors can cause infertility. Macroadenomas (tumors >10 mm) additionally give neurological symptoms: visual disturbances and headaches. Hyperprolactinemia in men most often leads to erectile dysfunction and decreased libido. With the time gynecomastia may develop. Testosterone substitution protects against the effects of hypogonadism. The erection and libido returns, but spermatogenesis is not improved. An effective therapy in such patients is the administration of exogenous gonadotropins.