Endocrine Abstracts

Background: FSH (Follicular stimulating hormone) secreting pituitary adenoma rare entity among functional pituitary tumors, with a few reported cases, almost certainly missed because of the lack of clinical examination skills. Approximately, 40-50% represent gonadotroph adenoma of all pituitary tumors. Only small percentage of these tumors secrete biologically active gonadotropins leading to gonadal stimulation.

Case presentation: Here, we report a unique case in a 26 old gentleman with a sellar tumor was referred to our hospital with suspected apoplexy. He had presented with complaints severe headache, nausea and vomiting of acute onset and gradual progressive vision loss in left eye since last 6 months. Visual assessment revealed absence of perception of light. Genital examination showed macroorchidism. Biochemical evaluation showed elevated FSH, with central hypothyroidism and hypocortisolemia. MRI brain with contrast showed, 5×5.7×8cm T1W and T2W heterogeneously hyperintense sellar-suprasellar lesion with septated cystic areas with air fluid levels suggestive of cystic solid pituitary macroadenoma. Patient was subjected to transcranial followed by trans-nasal resection of tumor with replacement of thyroxine and steroid hormones, subsequently there was fall in FSH levels.

Conclusion: Functional gonadotropin adenomas cause distinct manifestations. This case alert clinicians to consider possibility of FSH secreting pituitary adenoma in patients with testicular enlargement and elevated FSH.