Clinicopathological Characteristics of Plurihormonal Pituitary Adenoma

Abstract

BackgroundAs the pathogenesis of plurihormonal pituitary adenoma (PPA) is unclear and the diagnostic criteria are inconsistent, clinicians still find it challenging to diagnose. To analyze the relationship between clinical and pathological characteristics in PPA.MethodsThe clinical data of patients with 70 PPAs admitted during 2008–2010 and 2019–2020 were collected and analyzed. In particular, hormone examination using cell culture supernatant was performed to confirm PPA cases from 2019 to 2020.ResultsPPA accounted for 13% of all pituitary cases recorded in the same period. There were 30 men and 40 women. Fifty-three percent of patients had one endocrine manifestation, and 1% presented with two endocrine symptoms. However, none of the patients had three endocrine manifestations. The level of one and two types of hormones was elevated in 52 (74.3%) and 5 (7.1%) patients, respectively and that of three types of hormones was increased only in one patient. Immunohistochemical staining for PRL + TSH or FSH/LH was most commonly performed (n = 17), followed by that for PRL + GH + ACTH and PRL + GH + TSH or FSH/LH (n = 14) and PRL + ACTH (n = 10). The primary culture results in vitro were consistent with the pathological findings in five (41.7%) patients. Moreover, 4 of 12 patients diagnosed with PPA during 2019–2020 tested positive for SOX2.ConclusionThe pathogenesis of PPA remains elusive due to the lack of specific clinical symptoms and endocrine changes. Examination of hormones on tumor culture supernatant is helpful for its diagnosis.

Plurihormonal Pituitary Neuroendocrine Tumours – A Single Centre Experience

“…9 Intriguingly, in studies where immunohistochemistry for anterior pituitary transcription factors was not applied plurihormonal PitNETs account for up to 13%, potentially leading to wrong conclusions. 10 The first study presenting plurihormonal PitNETs diagnosed using anterior pituitary transcriptional factors was published in 2018, presenting five such tumours with positivity for PIT1, SF1 and ER. 8 A recent study reported 11 plurihormonal PitNETs diagnosed according to WHO 2022 criteria, five being non-functioning and six being functioning (five with acromegaly and one with prolactinoma).…”

Preoperative Risk Stratification of Increased MIB-1 Labeling Index in Pituitary Adenoma: A Newly Proposed Prognostic Scoring System

“…Hence, it is debatable whether this classification has some clinical implications. This phenomenon might be explained by the fact that hormones secreted by the PA are biologically inactive or that they lost their functioning after entry into the blood system [ 46 , 48 ]. Moreover, in the present series, we did not identify an association between p53 expression and an increased MIB-1 labeling index.…”

Pathogenesis, clinical features, and treatment of plurihormonal pituitary adenoma

“…53% of the patients had one clinical symptom, 1% had two endocrine symptoms, and none of the patients showed three or more endocrine symptoms. Of the patients, 74.3% had an elevated level of one hormone, 7.1% had an elevated level of two hormones, and only one had an elevated level of all three hormones ( Shi et al, 2022 ). Seckin et al analyzed the clinical features of 27 patients with PPA, 10 of whom were diagnosed with PAwUIC and 9 with PIT-1 + PPA.…”

“…Recent application of immunohistochemistry to pituitary tumors has shown that many pituitary adenomas, including clinically nonfunctional pituitary adenomas, are actually plurihormonal ( Salehi et al, 2006 ; Chinezu et al, 2017 ; Kobalka et al, 2021 ). Recent studies have also found that PPA accounts for 10–15% of all pituitary tumors ( Shi et al, 2022 ). PPA can be more aggressive than pituitary tumors that secrete a single hormone, with more than 50% of the tumors being locally aggressive ( Pawlikowski et al, 2010 ; Andrews et al, 2021 ).…”