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Clinical manifestations and diagnosis of gonadotroph and other clinically nonfunctioning pituitary adenomas

Author
Peter J Snyder, MD
Section Editor
David S Cooper, MD
Deputy Editor
Kathryn A Martin, MD

INTRODUCTION

Most patients with pituitary adenomas present with signs and symptoms of hormone hypersecretion (eg, hyperprolactinemia, growth hormone [GH] excess, or hypercortisolism). However, 25 to 30 percent of pituitary adenomas are clinically nonfunctioning or "silent"; 80 to 90 percent of these are gonadotroph adenomas, making them the most common type of pituitary macroadenoma. Patients with clinically nonfunctioning adenomas most often present with neurologic symptoms due to mass effects, while others may be completely asymptomatic and be first detected on an imaging study done for reasons other than pituitary symptoms or disease. By the time patients present, a high percentage has biochemical evidence of hypopituitarism due to compression of normal pituitary cells by the macroadenoma.

The clinical features, evaluation, and diagnosis of clinically nonfunctioning pituitary adenomas are reviewed here. The treatment of these tumors and an overview of incidentally discovered sellar masses (pituitary incidentalomas) are discussed separately. (See "Treatment of gonadotroph and other clinically nonfunctioning adenomas" and "Incidentally discovered sellar masses (pituitary incidentalomas)".)

OVERVIEW

Pituitary adenomas are classified by their cell of origin (lactotroph, gonadotroph, somatotroph, corticotroph, and thyrotroph) and their size (microadenomas <1 cm, macroadenomas ≥1 cm). Most adenomas (65 to 70 percent) secrete an excess amount of hormone including prolactin, growth hormone (GH), corticotropin (ACTH), or thyroid-stimulating hormone (TSH). (See "Causes of hyperprolactinemia" and "Causes and clinical manifestations of acromegaly" and "Causes and pathophysiology of Cushing's syndrome" and "TSH-secreting pituitary adenomas".)

The remainder of pituitary adenomas (30 to 35 percent) are clinically nonfunctioning or "silent." Of these, 80 to 90 percent are gonadotroph adenomas [1]. There are also clinically nonfunctioning somatotroph [2,3], lactotroph, and corticotroph adenomas [4], although these are less common.

The majority of gonadotroph adenomas are clinically "silent" and difficult to identify because they are poorly differentiated and produce and secrete hormones inefficiently. The gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), consist of a common alpha subunit, and a unique beta subunit. TSH and hCG also consist of the common alpha subunit and a unique beta subunit. The hormones secreted by gonadotroph adenomas in order of decreasing frequency include: FSH, FSH-beta, alpha subunit, LH, and LH-beta [5].

                                

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Literature review current through: Nov 2016. | This topic last updated: Wed Jul 20 00:00:00 GMT+00:00 2016.
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