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Pituitary tumor treatments

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How can Pituitary tumor affect fertility

Due to the pituitary's critical position, a pituitary tumor may disrupt gonadal function, either by its expanding size or the inappropriate secretion of hormones. Menstrual cycles may be disrupted even without hypogonadism (diminished functional activity of the gonads—the testes in males or the ovaries in females), particularly in the case of hormone-secreting adenomas. Despite optimal medical and surgical management of pituitary tumors, ovulation-induction therapy with gonadotropins is often required to restore fertility in these women. 

Prolactinomas are tumors arising from lactotroph cells in the pituitary gland that secrete prolactin, and are considered the most frequently diagnosed functioning pituitary tumor type, accounting for about 40% of all pituitary adenomas. In women, prolactinomas are usually microadenomas (<10 mm) presenting with high-prolactin levels, which leads to amenorrhea (absence of a menstrual period), and infertility. In males there is loss of libido, impotence and infertility and galactorrhoea (spontaneous flow of milk from the breast) depending on the prolactin levels. 

Tumor cells in patients with prolactinomas express estrogen receptors; as a result of the increased estrogen level during pregnancy, there can be a substantial increase in the volume of the prolactinoma. The main concern is possible tumor enlargement during pregnancy. The risk of tumor enlargement during pregnancy is found to depend on tumor size. Data in the literature indicate that although tumor enlargement is only 3% for microprolactinomas (<10 mm) it is as high as 32% for macroprolactinomas that were not previously operated on.

Also Gonadotropin-Secreting pituitary adenoma can cause infertility, in both females and males because of excess gonadotropins disrupt reproductive processes.

Symptoms are:

  • menstrual period changes,
  • low testosterone level in males,
  • loss of libido.

Prolactinomas are tumors arising from lactotroph cells in the pituitary gland that secrete prolactin, and are considered the most frequently diagnosed functioning pituitary tumor type, accounting for about 40% of all pituitary adenomas. In women, prolactinomas are usually microadenomas (<10 mm) presenting with high-prolactin levels, which leads to amenorrhea (absence of a menstrual period), and infertility. In males there is loss of libido, impotence and infertility and galactorrhoea (spontaneous flow of milk from the breast) depending on the prolactin levels. 

Tumor cells in patients with prolactinomas express estrogen receptors (group of proteins found inside and on cells) as a result of the increased estrogen level during pregnancy, there can be a substantial increase in the volume of the prolactinoma. The main concern is possible tumor enlargement during pregnancy. The risk of tumor enlargement during pregnancy is found to depend on tumor size. Data in the literature indicate that although tumor enlargement is only 3% for microprolactinomas (<10 mm) it is as high as 32% for macroprolactinomas that were not previously operated on.

Cushing Disease, one of associated diseases of pituitary tumor may also cause, reduced libido, impotence in men, and amenorrhoea and infertility in women due to elevations in androgens.


Pic. 2: Pituitary adenoma
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