Although believed to be rare, many nonfunctioning pituitary adenoma (NFPA) may stain for LH and or FSH and are gonadotrophin-producing (23). Most patients present with a macroadenoma and/or features of hypopituitarism (24).
Tumors may produce FSH, LH, and a-subunit, alone or in combination (25). Preoperative recognition of the pattern of hormone production is important for accurate diagnosis and for monitoring response to treatment. Initial management for these tumors is surgery, with the transsphenoidal approach used in the majority (26). Little data are available regarding the success of surgery, but it is likely that surgery alone is rarely curative. Measurement of hormone levels may act as a guide to surgical response, with later elevations suggestive of regrowth (27). Pituitary irradiation has a central role in the management of these tumors and is recognized to reduce recurrence rates. Medical therapies include the use of dopamine agonists, somatostatin analogs and gonadotropin-releasing hormone (GnRH) analogs, although success rates are generally low. Long-term surveillance with careful visual field and MRI assessment is mandatory in such patients, because tumor regrowth may occur. Measurement of gonadotropin levels and serum concentrations of a-subunit may sometimes be useful.
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