{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:36:30Z","timestamp":1760060190305,"version":"build-2065373602"},"reference-count":120,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: 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. Case Presentation: 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. Conclusions: 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\u2019 awareness of fertility-preservation options remain essential for improving outcomes.<\/jats:p>","DOI":"10.3390\/reports8030144","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T08:39:07Z","timestamp":1755247147000},"page":"144","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comprehensive Fertility Management After Pituitary Adenoma Surgery: Lessons from a Rural Japanese Case and Practical Review"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8040-9710","authenticated-orcid":false,"given":"Daisuke","family":"Numahata","sequence":"first","affiliation":[{"name":"Center for Human Reproduction, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi 329-2763, Japan"},{"name":"Department of Urology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi 329-2763, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6875-0874","authenticated-orcid":false,"given":"Kosuke","family":"Kojo","sequence":"additional","affiliation":[{"name":"Center for Human Reproduction, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi 329-2763, Japan"},{"name":"Department of Urology, Institute of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6961-2361","authenticated-orcid":false,"given":"San-e","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University, 3311-1, Shimotsuke, Tochigi 329-0498, Japan"},{"name":"Department of Endocrinology and Metabolism, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi 329-2763, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takumi","family":"Kuramae","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital Organisation Tochigi Medical Center, 1-10-37, Nakatomatsuri, Utsunomiya, Tochigi 320-8580, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7436-1647","authenticated-orcid":false,"given":"Ayumi","family":"Nakazono","sequence":"additional","affiliation":[{"name":"Center for Human Reproduction, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi 329-2763, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5348-3603","authenticated-orcid":false,"given":"Kaoru","family":"Yanagida","sequence":"additional","affiliation":[{"name":"Center for Human Reproduction, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi 329-2763, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7423-596X","authenticated-orcid":false,"given":"Hiroyuki","family":"Nishiyama","sequence":"additional","affiliation":[{"name":"Department of Urology, Institute of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3360-7688","authenticated-orcid":false,"given":"Tatsuya","family":"Takayama","sequence":"additional","affiliation":[{"name":"Center for Human Reproduction, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi 329-2763, Japan"},{"name":"Department of Urology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi 329-2763, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1007\/s12022-017-9498-z","article-title":"Overview of the 2017 WHO Classification of Pituitary Tumors","volume":"28","author":"Mete","year":"2017","journal-title":"Endocr. 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