Abstract
Transgender individuals usually receive long-term hormone treatment in the course of their sexual transition. Although the effects of this on possible development of neoplasia are largely unknown, very limited literature has suggested they may be predisposed to development of prolactinomas. We queried our databases to determine if we had encountered such cases at our tertiary care center for sellar region masses. Pathology databases from 2000–2019 were searched by the text word “transgender” to identify pituitary adenomas; cases were compared with all tissue specimens obtained from transgender persons. 2 pituitary adenomas were identified, out of approximately 1800+ sellar region masses at our institution during this same time period; neither were prolactinomas. The first occurred in a 71-year-old transgender male-to female who had undergone high-dose hormone therapy followed by orchiectomy 30 years prior; since that time various doses of estrogen had been received, most recently Premarin, .625 daily. Chronic hypertension associated with dizziness and vertigo prompted an endocrine workup which revealed an IGF-1 of 575 (normal < 150 ng/ml). MRI disclosed a 10 X 7 X 13 mm. pituitary mass which proved to be a mixed somatotroph/ lactotroph adenoma. The second occurred in a 53-year-old transgender female-to-male who was being evaluated by an endocrinologist for hormone therapy for his transition when a slightly elevated prolactin level was discovered. MRI disclosed a 10 x 7 x 13 mm. pituitary mass. Transsphenoidal hypophysectomy showed a gonadotroph adenoma with patchy immunostaining for follicle stimulating hormone (FSH). In comparison, during this same time period, 60 other surgical specimens had been received, including 33 bilateral mastectomies, 15 hysterectomies, and 4 orchiectomies, almost all for gender transition purposes. Clinicians and pathologists may wish to be aware of the occurrence of pituitary adenomas in transgender individuals, although the incidence is quite low (2/1800 sellar region masses in our system).