| Objective:to Understand the epidemiological characteristics,clinical symptoms,and tumor grade of pituitary FSH-secreting adenoma,and to analyze its hormone levels, surgical approach, and the degree of tumor resection. In addition to observe its major surgical complications, radiation therapy, and recurrence. Then to compare all the mentioned aspects with the ones of hormone immunonegative adenoma.In order to provide a reference for the diagnosis and treatment of FSH-secreting adenoma of the pituitary.Methods:In our hospital from January2007to December2011,304patients confirmed by pathology of pituitary FSH-secreting adenoma was as case group. And300patients from the same period in our hospital confirmed by pathology of pituitary immunonegative adenoma made a control group. The hospitalization data of two groups of patients was analyzed retrospectively and all the patients were followed-up for recurrence and postoperative treatment. The data were analyzed by SPSS software.Ressulits:The pituitary FSH-secreting adenoma accounted for9.25%of all pituitary adenomas, with a male to female ratio of approximately7:3. And the age of onset was21to80years, with a median age of53years old and most frequent in50to59years old. Then the age and gender distribution of the control group was similar as the case group, and the difference was not statistically significant.Impairment of visual system(63.5%), and headache (29.9%) were the most common clinical symptoms of pituitary FSH-secreting adenoma, also a lot of changes in gonadal function (19.7%). And the corresponding incidence of symptoms in the control group were59.7%,41.7%and21.3%.In the case group and control group the patients with Hardy grade III and above accounted for the majority, which was80.7%and71.8%, respectively.Serum FSH levels in male patients of case group was an average of15.03±7.16IU/L, which was far more higher than the control goup’s8.48±4.92IU/L, and the difference was statistically significant (P<0.01). After operation serum FSH levels in male patients of case group was an average of8.32±5.15IU/L, which was obviously decreased compared with before surgery, and the difference was statistically significant (P<0.01). When a male patient’s preoperative serum FSH level was higher than15.97IU/L, as the diagnostic criteria, and compared with the gold standard (pathology diagnosis), the sensitivity was23.4%, specificity90.6%. The case group’s male patients preoperative serum FSH levels correlated with the tumor size (r=0.306, P <0.01), and unrelated of age, while the control group was the opposite. Male patients both in case group and control group had shown a preoperative serum testosterone levels lower than normal, which was, respectively,6.89±3.78mmol/L and7.50±3.41mmol/L.Among case and control groups, each had87.2%and88.0%of patients undergone tumor resection via transsphenoidal approach, with a total resection of86.8%and85.6%each. And the rest were treated with craniotomy, with a total resection of51.5%and48.3%, respectively. Polyuria/diabetes insipidus, electrolyte imbalance and nasal complications were the most common surgical complications, and the mortality rate was less than1%.In case group,16patients received postoperative conventional external beam radiation, with13patients tumor controlled; at the same time10patients who underwent stereotactic gamma knife treatment, and9patients controlled. While the control group,19patients received postoperative conventional external beam radiation, with15patients tumor controlled;11patients who underwent stereotactic gamma knife treatment,10cases under control. The two groups of patients because of the radiation therapy influencing pituitary function, who need hormone replacement therapy accounted13and17cases, respectively.All patients were followed up for1.5to6years, an average of3years. In case group,252cases were followed up, while the control group,241cases, and the follow-up rates were82.9%and80.3%each.25patients (11.8%) turned out recurrence in case group, then12patients (6.1%) in the control group, and the difference was statistically significant (P<0.01). In case and control group,21and18patients occurred postoperative hypopituitarism, and the hormone replacement therapy was recommended.Conclusion:Pituitary FSH-secreting adenomas were clinically rare, mostly Dccurred in middle and aged men, According to the clinical symptoms and imaging findings was difficult to distinguish from hormone immunonegative adenoma. A male patient’s preoperative serum FSH level, when increasing significantly, had the value of differential diagnosis, and correlated with tumor size. Transsphenoidal approach was the most common choose, which achieved a higher total resection rate, and the ones whose tumor could not be resected totally might receive radiation therapy. |
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