Multiple meningiomas in two male-to-female transsexual patients with hormone replacement therapy: A report of two cases and a brief literature review

BACKGROUND: Exogenous sex hormones may play a role in meningioma development and growth. Thus, transsexual patients being on long-standing hormone replacement therapy (HRT) may be at particular risk for meningioma development and growth. Here we present two cases of two male-to-female transsexual patients taking HRT for an extended period of time with both patients requiring surgical treatment at our institution due to multiple growing meningiomas. CASE DESCRIPTION: The first patient was a 50-year-old genetic male (male-to-female transsexual) who presented 7 years after an extensive sex-change operation due to progressive bitemporal visual defects. The patient had been on HRT for approximately a decade. Radiological examinations showed a total of four meningiomas, one being a large suprasellar meningioma causing the symptoms. Three of the four meningiomas were operated on, but the patient's vision could not be saved. Immunohistochemical (IH) analysis of the meningiomas showed both estrogen and progesterone receptor expression. The patient continued HRT and during follow-up regrowth of the meningiomas was noted. The second patient was a 48-year-old genetic male (male-to-female transsexual) who had been on HRT for two decades and also presented due to left-sided visual loss. Radiological examination showed four meningiomas, one being a left-sided sinus cavernous meningioma causing compression of the visual apparatus. This patient had a previous normal head computerized tomography scan dating back 10 years before his current presentation. Three of the four meningiomas were operated on with a slight improvement in visual acuity. IH analysis showed positive progesterone receptor expression but negative estrogen receptor expression. CONCLUSION: Radiological screening may be justifiable for transsexual patients with a history of long-standing HRT and special focus should be paid to transsexual patients displaying new neurological symptoms or those already diagnosed with a meningioma.