The Intriguing Case of a Double Pituitary Adenoma

Abstract Purpose To explore the incidence of double pituitary adenomas in a tertiary center for pituitary surgery and asses their clinical, imaging and histopathological features. Methods The medical records of the patients operated on for pituitary tumors at the Department of Neurosurgery of Military Institute of Medicine in Warsaw, Poland between the years 2003 and 2018 were retrospectively analyzed. Among the 3270 treated patients, the diagnosis of double pituitary adenoma was established in 22 patients. Clinical, laboratory, detailed histopathological and diagnostics imaging data were collected and analyzed. Results There were 21 cases of synchronous and one case of asynchronous double pituitary adenoma. The main clinical finding was acromegaly (12/22) followed by Cushing’s disease (3/22). The diagnosis of synchronous double pituitary adenoma was suspected in the preoperative MRI in 11 patients. In the remaining patients the diagnosis of contiguous double pituitary adenoma was confirmed in the histopathological examination. There was no predilection for gender and the mean observation time was 74.2 months. In one case of Cushing’s disease the occurrence of double pituitary adenoma led to the initial failure of achieving hormonal remission. One patient presented with double pituitary adenomas as a manifestation of Carney complex. Conclusions Double pituitary adenoma is a rare entity that can pose a significant challenge especially in the setting of Cushing’s disease. Careful inspection of preoperative MRI and diagnostic work-up before transsphenoidal surgery and thorough histopathological microscopic examinations with immunohistochemical staining for all pituitary hormones is essential for establishing the diagnosis of double pituitary adenoma.

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A Double Pituitary Adenoma Presenting as a Prolactin-secreting Tumor with Partial Response to Medical Therapy. Case report

Endocrine Pathology ◽

10.1007/s12022-009-9104-0 ◽

2010 ◽

Vol 21 (2) ◽

pp. 135-138 ◽

Cited By ~ 10

Author(s):

Claire I. Coiré ◽

Harley S. Smyth ◽

Dominic Rosso ◽

Eva Horvath ◽

Kalman Kovacs

Keyword(s):

Case Report ◽

Pituitary Adenoma ◽

Partial Response ◽

Medical Therapy ◽

Double Pituitary Adenoma

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Metachronous Double Pituitary Adenoma with Altered Transcriptional Factor Profile: A Case Report and Literature Review

NMC Case Report Journal ◽

10.2176/nmccrj.cr.2021-0121 ◽

2021 ◽

Vol 8 (1) ◽

pp. 657-663

Author(s):

Akira TAGUCHI ◽

Yasuyuki KINOSHITA ◽

Atsushi TOMINAGA ◽

Vishwa Jeet AMATYA ◽

Yukio TAKESHIMA ◽

...

Keyword(s):

Case Report ◽

Pituitary Adenoma ◽

Literature Review ◽

Transcriptional Factor ◽

Double Pituitary Adenoma

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Abstract #831 The Intriguing Case of Double Pituitary Adenoma in a Patient Receiving Prednisone

Endocrine Practice ◽

10.1016/s1530-891x(20)47318-5 ◽

2018 ◽

Vol 24 ◽

pp. 188-189

Author(s):

Adriana Gonzalez ◽

Amit M. Saindane ◽

Nelson Oyesiku ◽

Adriana Ioachimescu

Keyword(s):

Pituitary Adenoma ◽

Double Pituitary Adenoma

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Association of pituitary adenoma with neuronal christoma: A TEM study

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010016889x ◽

1994 ◽

Vol 52 ◽

pp. 232-233

Author(s):

Eva Horvath ◽

Kalman Kovacs ◽

B. W. Scheithauer ◽

R. V. Lloyd ◽

H. S. Smyth

Keyword(s):

Growth Hormone ◽

Pituitary Adenoma ◽

Pituitary Tumor ◽

Nervous Tissue ◽

Alternative Explanation ◽

Growth Hormone Releasing Hormone ◽

Cell Hyperplasia ◽

Releasing Hormone ◽

Secretory Neurons

The association of a pituitary adenoma with nervous tissue consisting of neuron-like cells and neuropil is a rare abnormality. In the majority of cases, the pituitary tumor is a chromophobic adenoma, accompanied by acromegaly. Histology reveals widely variable proportions of endocrine and nervous tissue in alternating or intermingled patterns. The lesion is perceived as a composite one consisting of two histogenetically distinct parts. It has been suggested that the neuronal component, morphologically similar to secretory neurons of the hypothalamus, may initiate adenoma formation by releasing stimulatory substances. Immunoreactivity for growth hormone releasing hormone (GRH) in the neuronal component of some cases supported this view, whereas other findings such as consistent lack of growth hormone (GH) cell hyperplasia in the lesions called for alternative explanation.Fifteen tumors consisting of a pituitary adenoma and a neuronal component have been collected over a 20 yr. period. Acromegaly was present in 11 patients, was equivocal in one, and absent in 3.

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