Pawlikowski Łódź Marek, Jaranowska Maria, Fryczak Jolanta, Radek Maciej, Świętosławski Jacek, Kunert-Radek Jolanta, Winczyk Katarzyna
Department of Immunoendocrinology. Chair of Endocrinology, Medical University of Lodz, Sterling Str. 1/3, 91-425 Lodż, Poland.
Endokrynol Pol. 2018;69(5):526-529. doi: 10.5603/EP.a2018.0049. Epub 2018 Aug 3.
Although active gonadotropin-secreting pituitary adenomas are considered very rare, the vast majority of pituitary tumours diagnosed as "non-functioning" express gonadotropins or their free β or α subunits. However, systemic investigations comparing the serum concentrations of follitropin (FSH), lutropin (LH), and α-subunit (αSU) before surgery with the immunoreactivity of the respective substances in the excised tumours are still lacking.
Immunostaining of FSH, LH, and αSU was compared in 43 surgically removed gonadotropin - expressing pitu-itary adenomas with serum concentrations of the above-mentioned substances before surgery in the same patients.
The serum concentrations of FSH were elevated (> 11.6 mU/mL) in 8/12 (66.7%) cases of FSH-positive adenomas. By contrast, in FSH-negative tumours the elevation of FSH is absent. Moreover, only 1/25 (4%) patients with LH-positive adenoma had the elevated serum concentration of LH (51.5 mU/mL). The overproduction of LH was not observed in adenomas expressing free β LH or in LH-negative tumours. In patients with αSU-positive adenomas elevated serum levels of αSU were observed in 3/15 (20%) cases. No αSU elevations were observed in patients with αSU-negative adenomas. The mean serum FSH, LH, and αSU concentrations were higher in patients with FSH, LH, and/or αSU immunopositive tumours in comparison with immunonegative. However, the differences are not statistically significant.
Although "silent" gonadotropinomas constitute a frequent subtype of pituitary adenomas, the "active" subtype (i.e. manifesting by gonadotropin excess) are rare (approx. 4% of all pituitary adenomas). Gonadotropinomas are difficult to diagnose before surgery. The measurement of gonadotropins including αSU is needed but often not sufficient for presurgical diagnosis.
尽管分泌促性腺激素的垂体腺瘤被认为非常罕见，但绝大多数被诊断为“无功能”的垂体肿瘤表达促性腺激素或其游离的β或α亚基。然而，目前仍缺乏对手术前血清促卵泡生成素（FSH）、促黄体生成素（LH）和α亚基（αSU）浓度与切除肿瘤中相应物质免疫反应性进行比较的系统性研究。
对43例手术切除的表达促性腺激素的垂体腺瘤进行FSH、LH和αSU免疫染色，并将其与同一患者手术前上述物质的血清浓度进行比较。
在12例FSH阳性腺瘤中，8例（66.7%）患者的血清FSH浓度升高（>11.6 mU/mL）。相比之下，FSH阴性肿瘤患者的FSH浓度未升高。此外，在25例LH阳性腺瘤患者中，只有1例（4%）患者的血清LH浓度升高（51.5 mU/mL）。在表达游离β-LH的腺瘤或LH阴性肿瘤中未观察到LH分泌过多。在15例αSU阳性腺瘤患者中，3例（20%）患者的血清αSU水平升高。αSU阴性腺瘤患者未观察到αSU升高。与免疫阴性患者相比，FSH、LH和/或αSU免疫阳性肿瘤患者的血清FSH、LH和αSU平均浓度更高。然而，差异无统计学意义。
尽管“静止型”促性腺激素瘤是垂体腺瘤的常见亚型，但“活跃型”亚型（即表现为促性腺激素分泌过多）较为罕见（约占所有垂体腺瘤的4%）。促性腺激素瘤在手术前难以诊断。需要检测包括αSU在内的促性腺激素，但这对于术前诊断往往并不充分。
