Numahata Daisuke, Kojo Kosuke, Ishikawa San-E, Kuramae Takumi, Nakazono Ayumi, Yanagida Kaoru, Nishiyama Hiroyuki, Takayama Tatsuya
Center for Human Reproduction, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi 329-2763, Japan.
Department of Urology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi 329-2763, Japan.
Reports (MDPI). 2025 Aug 15;8(3):144. doi: 10.3390/reports8030144.
Pituitary adenomas, also termed pituitary neuroendocrine tumors, pose a significant risk of hypogonadotropic hypogonadism (HH) after surgical resection, with profound consequences for fertility and sexual function in young patients. We present the case of a 29-year-old man from rural Japan who developed severe HH and azoospermia following two transsphenoidal resections for a large pituitary adenoma. Despite early engagement with neurosurgery teams, fertility management was delayed by the absence of on-site endocrinology expertise and limited local oncofertility resources. After comprehensive endocrine evaluation and counseling, the patient began combined human chorionic gonadotropin and recombinant follicle-stimulating hormone therapy, resulting in full recovery of sexual function and normalization of semen parameters, ultimately leading to spontaneous conception and the birth of a healthy child. Building on this real-world case, we provide a narrative review of current practical management strategies for HH after pituitary surgery, including the utility of hormone-stimulation tests, Japanese guideline-based subsidy systems, and best-practice approaches to hormonal replacement. This case underscores not only the necessity for early, interdisciplinary collaboration and preoperative counseling but also highlights a rare instance in which a patient with a benign tumor received care that did not address his fertility-related needs, emphasizing that such considerations should be integrated into preoperative counseling even for non-malignant conditions. Strengthening regional oncofertility networks and improving healthcare providers' awareness of fertility-preservation options remain essential for improving outcomes.
垂体腺瘤，也称为垂体神经内分泌肿瘤，手术切除后有发生低促性腺激素性性腺功能减退（HH）的重大风险，对年轻患者的生育能力和性功能有深远影响。我们报告了一例来自日本农村的29岁男性病例，该患者因大型垂体腺瘤接受了两次经蝶窦切除术后出现严重HH和无精子症。尽管早期与神经外科团队进行了接触，但由于缺乏现场内分泌专业知识和当地肿瘤生育资源有限，生育管理被推迟。经过全面的内分泌评估和咨询后，患者开始接受人绒毛膜促性腺激素和重组促卵泡激素联合治疗，性功能完全恢复，精液参数正常化，最终自然受孕并诞下一名健康婴儿。基于这个真实病例，我们对垂体手术后HH的当前实际管理策略进行了叙述性综述，包括激素刺激试验的效用、基于日本指南的补贴系统以及激素替代的最佳实践方法。该病例不仅强调了早期跨学科合作和术前咨询的必要性，还突出了一个罕见的情况，即一名患有良性肿瘤的患者接受的治疗未解决其与生育相关的需求，强调即使对于非恶性疾病，此类考虑也应纳入术前咨询。加强区域肿瘤生育网络和提高医疗服务提供者对生育保留选择的认识对于改善结局仍然至关重要。
