ESPE Abstracts

Background: Functioning gonadotroph adenomas (FGAs) are very rare gonadotropin-secreting pituitary adenomas. Clinically, FGAs present only with mass effects. Nevertheless, central precocious puberty (CPP) has also been reported. Published data have demonstrated controversial opinions on the use of GnRH agonists in these patients, considering the risk of increase in tumor size and stimulating gonadotropin secretion. We herein report 3 cases diagnosed with CPP due to pituitary microadenoma in Alexandria University Children’s Hospital, and their course whether treated or not with GnRH agonists.

Case 1: A 4.6-year-old girl presented with precocious puberty; which started with breast enlargement at age 2 years, followed by cyclic vaginal bleeding for 4 months. Her height was 111.6 cm (+3SD), with bone age 11 years. She had breast Tanner III, no pubic or axillary hair, and a left preauricular skin tag. Ultrasound pelvis revealed a right ovarian cyst. Basal LH was pubertal, and serum estradiol level was elevated. MRI brain showed an enlarged pituitary gland, with a small pituitary microadenoma. She started GnRH agonist therapy. At age 5.7 years, her height is 116 cm (+0.4SD), Tanner staging didn’t progress, and her MRI showed a stationary course.

Case 2: A 7.8-year-old girl presented with breast enlargement Tanner III, and pubic hair Tanner II. Her height was 135 cm (+1.5SD), and her bone age was 8.5 years. Basal LH was prepubertal, so GnRH stimulation test was done showing pubertal response. Her brain imaging showed a pituitary microadenoma. Her ovaries and adrenals were normal by ultrasonography. After agreement with the parents, the decision was not to treat her. After 1 year, her growth velocity normalized, pubertal development didn’t progress, and the size of microadenoma remains the same.

Case 3: A 10-year-old boy presented with rapidly increasing height and pubic hair noticed since age 8 years. His height was +3.1SD, and he had advanced bone age (13 years). His physical examination revealed pubertal testicles, penile length 13 cm, and pubic hair Tanner IV. Basal LH and serum testosterone were significantly elevated. MRI brain showed a tiny pituitary microadenoma. He received GnRH agonists for 2 months, then he developed diplopia with right severe and left mild visual field defects, so he is planned for surgery.

Conclusions: Despite the scarcity of reported cases, FGAs can present with CPP. In these patients, the risk of using GnRH agonists needs to be kept in mind and further research is required to decide how to manage them.