Metástasis hipofisarias de tumores sólidos: 2 casos de diferente presentación / Pituitary metastasis of solid tumors: 2 cases of different presentation

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Meningioma sintomático inducido por tratamiento hormonal cruzado en un transexual hombre a mujer / Symptomatic meningioma induced by cross-sex hormone treatment in a male-to-female transsexual

El transexualismo se define como una fuerte convicción de pertenecer al sexo opuesto en aquellos individuos que no tienen ninguna patología intersexual. La terapia hormonal cruzada es un componente fundamental del tratamiento médico de los transexuales, pero debemos tener en cuenta que no está exenta de efectos adversos.Comunicamos un caso de meningioma en un transexual de hombre-mujer tratado con estrógenos y acetato de ciproterona durante 4 años, que consulta por cefalea y alteraciones visuales. Los análisis de sangre eran normales y en la resonancia magnética (RM) se describía una masa en el tubérculo sellar compatible con meningioma. Con estos resultados se interrumpió el tratamiento y se remitió al paciente a cirugía para resección del tumor. La histología tumoral confirmó un meningioma con receptores de progesterona muy positivos y receptores de estrógenos negativos. Tras la cirugía, el paciente desestimó continuar con el tratamiento hormonal cruzado por lo que se comenzó tratamiento con triptorelina (análogo de GnRH). Al año de seguimiento los síntomas habían mejorado significativamente y en la RM de control no había signos de recidiva tumoral.Este es el tercer caso publicado en la literatura de un meningioma tras tratamiento con estrógenos y progesterona. Consideramos muy importante el seguimiento a largo plazo de los pacientes transexuales que sean sometidos a esta terapia hormonal cruzada para detectar lo antes posible los efectos adversos derivados de la misma (AU)

Transsexualism is defined as a strong conviction of belonging to the opposite sex in individuals without any physical intersex condition. Cross-sex hormone therapy is an important component of medical treatment of transexuals but it is not exempt from adverse effects.We report a case of a meningioma in a male-to-female transsexual patient treated with estrogens and cyproterone acetate for the past 4years. He claimed recently severe headache and visual impairment. Blood tests showed normal results. A contrast-enhanced magnetic resonance imaging (MRI) scan revealed a mass in the tuberculum sellae consistent with a meningioma. Treatment was discontinued and tumor resection was performed. Histologic diagnosis confirmed strongly progesterone receptor-positive and estrogen negative meningioma. After surgery, the patient rejected the possibility of continuing with the treatment of estrogens and cyproterone, and so triptorelin (GnRH agonist) was initiated. At 1-year follow-up the patient's symptoms had ameliorated and a MRI scan revealed no recurrence of the tumor.This is the third case reported in the literature of a meningioma after treatment with estrogens and cyproterone acetate. We consider extremely important a long-term follow-up observation of male-to-female transsexual undergoing cross-sex hormone therapy in order to detect as soon as possible the adverse effects that can be derived from this therapy (AU)

Symptomatic meningioma induced by cross-sex hormone treatment in a male-to-female transsexual.

Transsexualism is defined as a strong conviction of belonging to the opposite sex in individuals without any physical intersex condition. Cross-sex hormone therapy is an important component of medical treatment of transexuals but it is not exempt from adverse effects. We report a case of a meningioma in a male-to-female transsexual patient treated with estrogens and cyproterone acetate for the past 4 years. He claimed recently severe headache and visual impairment. Blood tests showed normal results. A contrast-enhanced magnetic resonance imaging (MRI) scan revealed a mass in the tuberculum sellae consistent with a meningioma. Treatment was discontinued and tumor resection was performed. Histologic diagnosis confirmed strongly progesterone receptor-positive and estrogen negative meningioma. After surgery, the patient rejected the possibility of continuing with the treatment of estrogens and cyproterone, and so triptorelin (GnRH agonist) was initiated. At 1-year follow-up the patient's symptoms had ameliorated and a MRI scan revealed no recurrence of the tumor. This is the third case reported in the literature of a meningioma after treatment with estrogens and cyproterone acetate. We consider extremely important a long-term follow-up observation of male-to-female transsexual undergoing cross-sex hormone therapy in order to detect as soon as possible the adverse effects that can be derived from this therapy.