Purpose of Study To present a case of a gonadotroph adenoma with markedly elevated testosterone levels. A review of relevant literature is also included.
Methods A 61-year-old African American male was referred for evaluation of persistent headaches. Symptoms initially started 5 months earlier with bifrontal, pounding headaches and right temporal hemianopia. He admitted to decreased sexual activity and overall energy level, as well as increased facial hair growth. He denied any galactorrhea or enlargement of hands or feet. Examination was significant for mildly enlarged testes but no testicular masses. MRI revealed a pituitary macroadenoma measuring 2.7 × 2.2 cm, with extension into the right cavernous sinus and elevation of the optic chiasm.
Results Laboratory workup to assess for secretory capacity was initiated. Prolactin was 24 ng/mL (2.1-17.7 ng/mL), LH 15.7 mIU/mL (1.5-9.3 mIU/mL), FSH 102.9 mIU/mL (1.4-18.1 mIU/mL), and total testosterone 2,270 ng/dL (241-827 ng/dl). He subsequently underwent successful transsphenoidal resection of the adenoma. Immunoperoxidase staining of the tissue was strongly positive for LH and weakly positive for FSH. Eighteen days postoperatively, laboratory results showed LH 1.6 mIU/mL, FSH 18.1 mIU/mL, and total testosterone 58 ng/dL.
Conclusions Gonadotroph adenomas may produce supranormal concentrations of intact LH, which can rarely cause a supranormal testosterone concentration. The endocrinologist should be aware of this entity to facilitate diagnosis in the future.
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