Silent pituitary neuroendocrine tumor in a trasgender patient: diagnostic and therapeutic challenge

Abstract

Approximately 20% of transgender women will develop hyperprolactinemia after initiation of hormone treatment; although they may return to normal values with a decrease in the dose of estradiol, a group will develop persistent hyperprolactinemia with enlarged pituitary glands and PitNET lactotrophs, to a lesser extent. A case is presented of a 69-year-old patient with gender dysphoria, who began gender-affirming hormonal therapy with high-dose estrogens, GnRH analogues and antiandrogens, which he received intermittently with irregular medical controls, presenting 10 years later a decrease in visual acuity, bitemporal hemianopsia and frontotemporal headache, of moderate intensity, which has increased in intensity and frequency in the last 2 months. Laboratory tests were requested that reported prolactin 107 ng/ml and diluted prolactin 115.4 ng/ml and the imaging study revealed a space occupation lesion located in the sellar area, measuring 2.5 x 2.4 cm, with hyperintensity on T1 and T2 weighting, with suprasellar extension, compression of the optic chiasm and invasion of the right cavernous sinus. A silent pituitary neuroendocrine tumor is considered and due to the compromise of the visual field, surgical resolution is planned. Pituitary neuroendocrine tumors can occur as a result of estrogen use in transgender women, so serum prolactin concentrations should be monitored annually. No causal association has been demonstrated between GAHT use and silent pituitary neuroendocrine tumor.