Atypical Pituitary Adenoma: A Clinicopathologic Case Series

Abstract Few studies have focused on histological patterns of metastatic spread to the pituitary gland. We review our experience and that in the literature, 1970–present. Departmental cases, 1998–2021, were assessed for anterior versus posterior gland and/or capsular involvement and cohesive tumor obliterating underlying pituitary architecture versus metastatic cells filling pituitary acini with relative acinar preservation. Eleven autopsy/15 surgical cases, including 2 metastases to pituitary adenomas, were identified. Cohesive/obliterative patterns predominated histologically in both surgical and autopsy cases, but acinar filling by metastatic cells was extensive in 3/26 cases, focal in 5/26, and had resulted in initial erroneous impressions of atypical pituitary adenoma/pituitary carcinoma in 1 case and pituitary adenoma with apoplexy in another, likely due to focusing on necrotic areas in the specimen where the acinar pattern had been broken down and not appreciating nearby areas with acinar filling by metastatic cells. Although most pituitary metastases produce readily identifiable cohesive/obliterative patterns, diagnostic challenges remain with the less frequently seen “acinar filling” pattern. A dichotomy exists between patients with symptomatic pituitary metastases occurring early in the disease course and requiring surgical excision versus patients in whom asymptomatic small pituitary metastases are found incidentally at autopsy, the latter almost invariably in late disease stages, with widely disseminated metastatic disease.

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Markers of Metabolic Syndrome in Patients with Pituitary Adenoma: A Case Series of 303 Patients

Hormone and Metabolic Research ◽

10.1055/a-1020-3992 ◽

2019 ◽

Vol 51 (11) ◽

pp. 709-713 ◽

Cited By ~ 2

Author(s):

Seher Çetinkaya Altuntaş ◽

Mehtap Evran ◽

Murat Sert ◽

Tamer Tetiker

Keyword(s):

Metabolic Syndrome ◽

Pituitary Adenoma ◽

Waist Circumference ◽

Case Series ◽

Low Density Lipoproteins ◽

Control Group ◽

Newly Diagnosed ◽

Patient Groups ◽

Relationship Of ◽

Age And Sex

AbstractTo assess the demographic characteristics and hormonal status of patients who presented to our clinic with pituitary adenoma and to demonstrate the presence, prevalence, and relationship of metabolic syndrome parameters in these patients. The study included 303 patients with known or newly diagnosed pituitary adenoma and 52 age- and sex-matched healthy controls. The patients were classified into 3 groups; acromegaly (ACRO) (n=54),prolactinoma (PRLoma) (n=163), and non-functional adenoma (NFA) (n=86). in 55.6% (n=172) and 52% (n=163) of the patients, respectively. The waist circumference of all patients (p<0.001) and body mass index (BMI) of patients with PRLoma (p=0.03) and ACRO (p<0.001) were found to be significantly higher than in the controls. The HbA1c, insulin and HOMA-IR values were significantly higher in the ACRO and PRLoma groups, whereas the insulin and HOMA-IR values were significantly higher in the NFA group compared with the control group (p<0.001 and p<0.001, respectively). When the 3 patient groups were compared, waist circumference and BMI were significantly higher in the ACRO group than in the PRLoma group (p=0.04 and p=0.03, respectively). In patients developing pituitary failure after treatment, age, waist circumference, plasma glucose, low-density lipoproteins and triglyceride values were significantly increased when compared with those without pituitary failure after treatment (p<0.001). In our study, it was found that there was increased metabolic and cardiovascular risk in functional pituitary adenoma and NFA.

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Prediction Tumour Bed Bleeding Between MRI Features and Histopathological Findings in Atypical Pituitary Adenoma

Nanoscience and Nanotechnology Letters ◽

10.1166/nnl.2017.2587 ◽

2017 ◽

Vol 9 (12) ◽

pp. 2126-2132

Author(s):

Wei-Ming Lin ◽

Wen-Chang Chen ◽

Chia-Hui Chen ◽

Song-Shei Lin ◽

Lan Zhang

Keyword(s):

Pituitary Adenoma ◽

Histopathological Findings ◽

Mri Features ◽

Atypical Pituitary Adenoma

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MON-303 Giant Growth Hormone Secreting Pituitary Adenomas: A Single Institution Case Series

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1110 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Bahadir Koylu ◽

Suleyman Nahit Sendur ◽

Seda Hanife Oguz ◽

Selcuk Dagdelen ◽

Tomris A Erbas

Keyword(s):

Growth Hormone ◽

Pituitary Adenoma ◽

Pituitary Adenomas ◽

Postoperative Radiotherapy ◽

Somatostatin Receptor ◽

Case Series ◽

Tumor Diameter ◽

Somatostatin Receptor Ligands ◽

The Mean

Abstract The prevalence of growth hormone (GH)-secreting pituitary adenoma is around 11-13% of all pituitary adenomas. Giant GH-secreting pituitary adenomas (≥ 4 cm) are rare tumors, and its prevalence of among acromegalic patients is <5%. This is a retrospective cohort study including patients with giant GH-secreting pituitary adenomas. The study population consisted of 10 patients (5 M/5 F). The mean age at diagnosis was 33.0±12.9 yrs (11-55 yrs). The mean delay between first symptom onset and diagnosis was 2.9 years. The most frequent symptoms were acral enlargement and facial changes (80%), followed by headache (70%) and visual deterioration (50%). One patient had epilepsy. Amenorrhea was presented in three females but obvious galactorrhea in two. The mean adenoma diameter was 42.6±4.7 mm (40-51 mm) at diagnosis. The vast majority of adenomas presented suprasellar extension (100%) or cavernous sinus invasion (80%). Cystic adenomas accounted for 50%. At presentation, mean GH and IGF-1 levels were 40.0±21.4 ng/mL (14.8-51.0) and 2.62±1.09 x ULN (1.08-3.96), respectively. Six patients presented with PRL cosecretion. At diagnosis maximal tumor diameter was not correlated with GH or IGF-1 levels. All patients underwent pituitary surgery as first-line treatment. Three cases were treated with an endoscopic approach and four cases with a microscopic approach. Transcranial approach was also employed in three cases. Postoperative mean GH and IGF-1 levels were 14.9±16.1 ng/mL (0.6-51.0) and 2.25.±0.82 x ULN (1.48-3.74), respectively. After first surgery, only one patient had more than 50% reduction in IGF-1 levels. Five patients (50%) underwent repeat surgery on two to three procedures because remission was not achieved. Postoperative somatostatin receptor ligands (SRLs) were used by all patients. Six patients were treated with dopamine agonist in combination with SRL. Six patients (60%) received postoperative radiotherapy. The mean follow-up period was 12.6±5.3 yrs (4-21 yrs). The mean GH and IGF-1 levels were 1.47±1.54 ng/mL (0.08-5.25) and 0.73±0.44 x ULN (0.08-1.56), respectively at the last visit. Residual adenoma was present at the last MRI in eight patients (mean diameter 9.0±3.6 mm). Panhypopituitarism rose from 10% at baseline to 30% at the last visit. During follow-up, one patient diagnosed breast cancer, while another diagnosed thyroid papillary cancer. Giant GH-secreting pituitary adenomas can have a clinically aggressive behavior with mass effect. Moreover, treatment in patients with giant GH-secreting pituitary adenoma is complex and multimodal therapy is necessary.

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SUPRASELLAR TUMORS

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.04.357 ◽

2018 ◽

Vol 25 (04) ◽

pp. 603-609

Author(s):

Farrukh Zulfiqar ◽

Atiq Ahmed Khan ◽

Muhammad Imran ◽

Syed Ijlal Ahmed ◽

Syeda Beenish Bareeqa ◽

...

Keyword(s):

Visual Acuity ◽

Pituitary Adenoma ◽

Cross Section ◽

Case Series ◽

P Value ◽

Visual Improvement ◽

Visual Deficit ◽

Visual Status ◽

Study Setting

Objectives: Our aim was to analyze the postoperative visual status in patientswith suprasellar tumors with preexisting preoperative visual deficit after surgical resection.Study Design: Comparative cross section study. Setting: Civil Hospital Karachi. Period:March 2013 to August 2016. Methods: A total of 107 patients with suprasellar tumors withpreoperative visual deficit who were operated. Either via transsphenoidal (43) or transcranial(64) approaches, were included in this case series. Sixty six patients had pituitary adenomas,24 had craniopharyngiomas, 13 had meningiomas, 3 had chordomas and 1 had epidermoidcyst. Twenty five patients had uniocular visual deficit and 82 had binocular. Visual acuity wasrecorded preoperatively, postoperatively at discharge and at four weeks follow-up. Results:Postoperatively 46% of eyes improved, while 34.4% and 19.6% remained same and deterioratedrespectively. Patients underwent transsphenoidal technique got significant 65% improvement,and those who underwent transcranial had 37.5% improvement (p-valve=0.005). Pituitaryadenomas showed the greatest visual improvement of 65% (p-value=0.000), followed bycraniopharyngiomas (33.5%) and meningiomas (7.6%). In total 52 patients (48.6%) showedimprovement in vision and the visual acuity of remaining 55 (51.4%) did not improve. Conclusion:Patients experience significant benefit in vision after decompressive surgery for suprasellartumors, especially those who have pituitary adenoma and who undergo transsphenoidaltechnique.

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