Background/Objectives: Gonadotroph adenomas (GA), classically known as poorly differentiated tumors that secrete hormones inefficiently, are often misdiagnosed as nonfunctioning macroadenomas (NFA) 1 .Our series aims to challenge conventional views on GA as uniformly silent by demonstrating these tumors can exhibit subtle to overt hormonal and structural activity with significant clinical consequences.This series serves as a resource to general endocrinologists with an approach that enables early functional GA (FGA) recognition and treatment.Case Series: A premenopausal woman with recurrent resistant FGA and ovarian hyperstimulation syndrome (OHSS) was managed over ten years with multiple surgeries and medical therapies.Two men presented with visual decline and abnormal gonadotropin biochemical testing.Discussion: Despite most being clinically silent, GA variably express gonadotropin hormones by immunohistochemistry (IHC).A clinically significant subset presents with increased serum gonadotropins which can lead to infertility, OHSS, and testicular enlargement.The pathogenesis is not well established, but it has been shown that gonadotropin releasing hormone receptor (GnRHR) gene expression is enriched in FGA compared to non-functioning GA.Resection is the standard upfront treatment with medical therapy and consideration of radiation therapy in recurrent/refractory cases. Conclusion:FGA exists in a functional spectrum rather than as uniformly silent tumors.Transsphenoidal surgery (TSS) remains the mainstay of therapy.Medical management may provide periods of short-term control.This study aims to increase awareness of the not-so-silent and not-so-rare presentations of GA and describe management strategies.
Lim et al. (Sun,) studied this question.