Endocrine Abstracts

Introduction: The prevalence of functioning gonadotropinoma is difficult to assess since most of reports are case reports. Gonadotropinomas rarely lead to a noticeable clinical syndrome. They usually produce symptoms associated with mass effect such as headaches, visual field impairment and hormonal deficiencies.

Case report: We present the case of a 38 years old women diagnosed in 2017 with microprolactinoma. She had elevated prolactin level (108 ng/ml) and a small pituitary adenoma with 9/8 mm in diameter. She was treated with dopamine agonist for 3 weeks after the diagnosis, treatment stopped afterwards due to side effects. In follow-up examinations prolactin level normalized with no treatment, IRM exam revealed 2 pituitary microadenomas (4/3/6 mm and 3.7/2.5/3.5 mm respectively) and she developed bilateral ovarian cysts. She underwent surgical intervention and the cysts were evacuated, but after 1 month, at next follow-up the cysts reappeared. In our department she presented with headache, amenorrhea and recurrent bilateral ovarian cysts. Serum prolactin was normal but she had a high serum estradiol level (963.2 pg/ml) with a FSH and LH of 2.01 mUI/ml and 2.36 mUI/ml respectively. This was enough to raise the suspicion of a functional gonadotropinoma, unfortunately we could not measure serum gonadotropin hormone alpha-subunit to confirm the diagnosis.

Conclusion: The patient initially presented with a prolactin producing pituitary microadenoma and later developed a second pituitary adenoma. The elevated estradiol level and recurrent bilateral ovarian cysts raised the suspicion of a functional gonadotropinoma. The patient needs further evaluation to confirm the diagnosis.