From the Guidelines
Pituitary adenomas disrupt sex hormones by either overproducing or underproducing hormones that regulate sexual function, leading to various symptoms such as low testosterone, irregular periods, infertility, and hypogonadism. These tumors can directly secrete excess hormones like prolactin, growth hormone, or ACTH, or they can compress normal pituitary tissue, leading to hormone deficiencies 1. The most common type, prolactinomas, cause elevated prolactin levels that suppress gonadotropin production (FSH and LH), resulting in low testosterone in men and irregular periods or infertility in women. Growth hormone-secreting adenomas can cause sexual dysfunction through insulin resistance and altered estrogen metabolism. Non-functioning adenomas may compress the normal pituitary, causing hypogonadism with symptoms like decreased libido, erectile dysfunction, menstrual irregularities, and infertility.
Some key points to consider:
- Genetic assessment is crucial in the management of pituitary adenomas, especially in children and young people, as it can inform treatment and family surveillance 1.
- Transsphenoidal surgery is the technique of choice for pituitary adenomas, even in patients with incompletely pneumatized sphenoid sinuses 1.
- Treatment depends on the tumor type and may include dopamine agonists like cabergoline for prolactinomas, surgery for other functioning adenomas, and hormone replacement therapy for deficiencies.
- The pituitary's central role in the endocrine system explains why these tumors have such profound effects on sexual function through their impact on the hypothalamic-pituitary-gonadal axis.
- A multidisciplinary team approach is essential in the management of pituitary adenomas in children and young people to improve health outcomes and quality of life 1.
From the Research
Pituitary Adenomas and Sex Hormones
Pituitary adenomas can disrupt sex hormones in several ways:
- Hypogonadism: Approximately 53% of pituitary adenomas are prolactinomas, which can cause hypogonadism, infertility, and/or galactorrhea 2, 3.
- Hypersecretion of hormones: Pituitary adenomas can hypersecrete hormones, including prolactin, growth hormone, and adrenocorticotropic hormone, leading to various clinical syndromes such as hyperprolactinemia, acromegaly, and Cushing disease 2, 3, 4.
- Gonadotroph adenomas: Rarely, gonadotroph adenomas can induce an ovarian hyperstimulation syndrome in females or an increase in testosterone levels in males 5.
- Sex hormone imbalance: The disruption of sex hormones can lead to symptoms such as infertility, decreased libido, and galactorrhea in women, and loss of libido, erectile dysfunction, and infertility in men 3, 4.
Types of Pituitary Adenomas
The main types of pituitary adenomas that can affect sex hormones are:
- Prolactinomas: Account for 32% to 66% of adenomas and present with amenorrhea, loss of libido, galactorrhea, and infertility in women, and loss of libido, erectile dysfunction, and infertility in men 3.
- Gonadotroph adenomas: Can secrete follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH), resulting in an increase in serum levels, but rarely lead to elevated sex hormone levels 5.
- Nonfunctioning adenomas: Account for 15% to 54% of adenomas and present with mass effects, but do not typically produce hormones that affect sex hormones 3, 4.
Treatment and Management
Treatment and management of pituitary adenomas that disrupt sex hormones involve:
- Dopamine agonists: Primary treatment for prolactinomas 2, 3, 4.
- Transsphenoidal surgery: First-line therapy for other pituitary adenomas requiring treatment 2, 3.
- Medical therapy: May be used in combination with surgery or as an alternative to surgery 2, 3, 6.
- Multidisciplinary approach: Involves a team of endocrinologists, neurosurgeons, and other specialists to manage the tumor and its effects on sex hormones 6.