Objective: To describe a patient with a clinically nonfunctioning pituitary
macroadenoma who presented with mild hyperprolactinemia and amenorrhea.
Design: Case report.
Setting: Tertiary care medical facility.
Patient(s): A 44-year-old woman with a 6-month history of amenorrhea. Inter
vention(s): Pituitary testing, magnetic resonance imaging of the sella turc
ica, and transsphenoidal surgery.
Main Outcome Measure(s): Pituitary function testing, magnetic resonance ima
ging, and return of menstrual cycles.
Result(s): Baseline laboratory data revealed a serum prolactin level of 34
ng/mL (normal range, 3-20 ng/mL), normal thyroid function test results, and
an FSH level of 6.7 mIU/mL. A second fasting prolactin level was 48 ng/mL.
Magnetic resonance imaging of the sella turcica revealed a pituitary macro
adenoma measuring 1.4 x 3.2 cm. Further testing of baseline pituitary funct
ion revealed normal findings. The patient underwent an; uncomplicated trans
sphenoidal resection of the pituitary tumor and maintained normal pituitary
function. Pathologic evaluation revealed a pituitary adenoma that stained
positive for FSH and focally for the ct subunit. The adenoma stained negati
ve for GH, prolactin, ACTH, LH, and TSH.
Conclusion(s): This patient had a nonsecreting gonadotroph macroadenoma tha
t resulted in hypogonadotropic hypogonadism along with mild hyperprolactine
mia, presumably secondary to interruption of normal transport down the pitu
itary stalk. (Fertil Steril(R) 1999;72:663-5. (C) 1999 by American Society
for Reproductive Medicine.).