Masking Andropause by a Functioning Gonadotroph Macroadenoma: Discordant Clinical and Hormonal Findings
https://doi.org/10.15605/jafes.041.S1
- Author:
Niken Febriharsari
1
;
Mirza Adhyatma
1
;
Hemi Sinorita
2
Author Information
1. Endocrinology, Metabolism, and Diabetes Fellowship Program, Gadjah Mada University, Dr. Sardjito General Hospital
2. Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Gadjah Mada University, Dr. Sardjito General Hospital
- Publication Type:Journal Article
- MeSH:
Male;
Andropause;
Gonadotrophs
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):84-85
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Functioning gonadotroph adenomas (FGPAs) in males
are rare and typically present with macroorchidism. In
elderly patients, the presentation can be confounding.
This case illustrates a unique scenario where a pituitary
tumor masked the physiological decline of testosterone,
maintaining the patient’s stamina despite Introduction
testicular involution.
Case:A 65-year-old male was referred for a pituitary macroadenoma (10.7 × 10.6 × 11.4 mm) following progressive
headaches. Remarkably, the patient denied symptoms
of andropause; his stamina, mood, and libido were wellpreserved. Investigations revealed elevated folliclestimulating hormone (15.42 mIU/mL) and luteinizing hormone (12.1 mIU/mL) with normal testosterone levels.
Scrotal ultrasound showed bilateral testicular involution
(right: 8.66 mL, left: 7.21 mL), contradicting the expected
macroorchidism of FGPA. Although the patient felt his
vision was normal, a confrontation test revealed temporal
visual field defects, indicating chiasmatic compression. This
case presents a striking clinical discordance where tumorinduced gonadotropin hypersecretion provided a supraphysiological drive to the involuting testes, maintaining
testosterone levels and masking andropause. The primary
indication for transsphenoidal surgery is the Introduction
evidence of visual field defects. However, removing
the adenoma will abruptly eliminate this “hormonal
drive.” Postoperative management will focus on rigorous
hormonal monitoring. Testosterone replacement therapy
is not immediately indicated; rather, it will be carefully
planned only if postoperative evaluations demonstrate a
significant hormonal decline accompanied by symptomatic
hypogonadism. This tailored approach ensures that the
benefits of intervention outweigh the potential risks in
an elderly patient.
Conclusion:In elderly patients, FGPAs can mask age-related hormonal
decline. In this case, clinicians must treat the patient,
not just the tumor. Anticipating a potential decline in
postoperative stamina is as crucial as the surgery itself.
Comprehensive hormonal evaluation and a personalized
approach to therapy are essential to preserve quality of life
after the “masking” effect is removed.
- Full text:2026080414190716373EP_A118.pdf
