Pituitary tumors and the risk of other malignancies: is the relationship coincidental or causal?

Abstract

Pituitary adenomas are benign neoplasms of the pituitary. The most prevalent are prolactinomas and nonfunctioning pituitary adenomas, followed by growth hormone- and ACTH-secreting adenomas. Most pituitary adenomas seem to be sporadic and their persistent growth is very atypical. No molecular markers predict their behavior. The occurrence of pituitary adenomas and malignancies in the same patient can be either pure coincidence or caused by shared underlying genetic susceptibility involved in tumorigenesis. Detailed family history on cancers/tumors in the first, second and third generation of family members on each side of the family has been reported in a few studies. They found an association of pituitary tumors with positive family history for breast, lung and colorectal cancer. We have reported that in about 50% of patients with pituitary adenomas an association with positive family history for cancer has been found independent of secretory phenotype (acromegaly, prolactinoma, Cushingʼs disease or non-functioning pituitary adenomas). We also found earlier onset of pituitary tumors (younger age at diagnosis of pituitary tumors) in patients with strong family history of cancer. In our recent unpublished series of 1300 patients with pituitary adenomas, 6.8% of patients were diagnosed with malignancy. The latency period between the diagnosis of pituitary adenoma and cancer was variable and in 33% of patients was longer than 5 years. Besides the inherited trophic mechanisms (shared underlying genetic variants), the potential influence of shared complex epigenetic influences (environmental and behavioral factors -obesity, smoking, alcohol intake, insulin resistance) is discussed. Further studies are needed to better understand if patients with pituitary adenomas are at increased risk for cancer.

Beyond Occam's Razor: Concurrent Non-functional Pituitary Macroadenoma and Metastatic Hepatocellular Carcinoma in a Patient With Functional Cure of Hepatitis B

“…The association between NFPA and an increased risk of malignancy remains controversial [ 19 ]; thus, the co-occurrence of NFPA and HCC in our patient may be coincidental. Intriguingly, the oncogene pituitary tumor-transforming gene 1 (PTTG1), first identified in pituitary tumors in rats [ 20 ], is expressed in nearly 90% of NFPA cases [ 21 ].…”

The sellar region as presenting theater for hematologic malignancies—A 17-year single-center experience

“…In the view of clinically and histologically excluded acromegaly, her mildly elevated IGF-1 (unaffected by treatment), could not be attributed to multiple myeloma as its source, but may have played a role in disease occurrence or progression. Populationwide studies associated a high normal IGF-1 with increased risk of various malignancies, including breast, prostate, lung and colorectal cancer [50]. In previous studies, elevated IGF-1 was not confirmed in multiple myeloma (MM) patients, but higher serum IGF-1 level was associated with worse prognosis of the disease [51].…”

Impact of Heavy Metals on Glioma Tumorigenesis

“…Pituitary adenomas are tumors, generally benign, of the pituitary gland. Recently, it has been hypothesized that heavy metals can also increase the risk of the onset of pituitary adenomas [75]. It is probable that, on the basis of this, there is a possible interaction between the AIP (Aryl hydrocarbon receptor-interacting protein)-AhR pathway and heavy metals.…”