Pituitary tumours — a large retrospective single-centre study of over 2300 cases. Experience of a tertiary reference centre
, 4, 5, 62, 4, 5, 6
Abstract
Introduction: Pituitary adenomas (PAs), also known as a pituitary neuroendocrine tumours (PitNET), are usually benign tumours of the anterior lobe of the pituitary gland and account for the third most common intracranial neoplasm. The most common type of pituitary adenoma is lactotroph adenoma, in which dopamine agonists are the first-line treatment. Nevertheless, in selected cases surgery or even radiotherapy may be required. In the current study, we aimed to analyse all patients who underwent surgery due to intrasellar mass in order to evaluate frequency of particular pituitary tumours, clinical diagnosis, and pathology findings.
Material and methods: We retrospectively analysed all cases of patients consecutively operated due to intrasellar mass between 1st January 2010 and 31st December 2018 at the Department of Neurosurgery, Military Institute of Medicine in Warsaw, Poland.
Results: Our database included 2348 cases: 1390 women (59.2%) and 958 men (40.8%). The mean age for women was 48.4 years (SD ± 15.72; median 49) and for men 50.9 years (SD ± 14.94; median 53). In our cohort we found: 869 gonadotroph and null cell adenomas, 751 somatotroph and mammosomatotroph adenomas, 386 corticotroph adenomas, 71 plurihormonal adenomas, 59 craniopharyngiomas, 44 lactotroph adenomas, 18 purely thyrotroph adenomas, and other rare cases of pituitary tumours including one pituitary carcinoma metastasising to the liver (corticotroph origin).
Conclusions: We provide a comprehensive analysis of both clinical and pathological findings of the largest cohort of patients operated on for pituitary adenomas in one tertiary reference centre. To the best of our knowledge, this is the largest up-to-date published analysis in our country.
Keywords: pituitary adenomasPaspituitary neuroendocrine tumoursPitNETretrospective single-centre analysis
References
- Asa S, Ezzat S. The Cytogenesis and Pathogenesis of Pituitary Adenomas*. Endocr Rev. 1998; 19(6): 798–827.
- Daly AF, Rixhon M, Adam C, et al. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab. 2006; 91(12): 4769–4775.
- Daly A, Tichomirowa M, Beckers A. The epidemiology and genetics of pituitary adenomas. Best Pract Res Clin Endocrinol Metab. 2009; 23(5): 543–554.
- Tjörnstrand A, Gunnarsson K, Evert M, et al. The incidence rate of pituitary adenomas in western Sweden for the period 2001–2011. Eur J Endocrinol. 2014; 171(4): 519–526.
- Drummond J, Roncaroli F, Grossman AB, et al. Clinical and Pathological Aspects of Silent Pituitary Adenomas. J Clin Endocrinol Metab. 2019; 104(7): 2473–2489.
- Mete O, Hayhurst C, Alahmadi H, et al. The role of mediators of cell invasiveness, motility, and migration in the pathogenesis of silent corticotroph adenomas. Endocr Pathol. 2013; 24(4): 191–198.
- Nishioka H, Inoshita N. New WHO classification of pituitary adenomas (4th edition): assessment of pituitary transcription factors and the prognostic histological factors. Brain Tumor Pathol. 2018; 35(2): 57–61.
- Nishioka H, Inoshita N, Mete O, et al. The Complementary Role of Transcription Factors in the Accurate Diagnosis of Clinically Nonfunctioning Pituitary Adenomas. Endocr Pathol. 2015; 26(4): 349–355.
- Knosp E, Steiner E, Kitz K, et al. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993; 33(4): 610–7; discussion 617.
- Zieliński G, Sajjad EA, Maksymowicz M, et al. Double pituitary adenomas in a large surgical series. Pituitary. 2019; 22(6): 620–632.
- Mete O, Cintosun A, Pressman I, et al. Epidemiology and biomarker profile of pituitary adenohypophysial tumors. Mod Pathol. 2018; 31(6): 900–909.
- Lopes MB. The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. Acta Neuropathol. 2017; 134(4): 521–535.
- Melmed S, Casanueva FF, Hoffman AR, et al. Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96(2): 273–288.
- Eroukhmanoff J, Tejedor I, Potorac I, et al. MRI follow-up is unnecessary in patients with macroprolactinomas and long-term normal prolactin levels on dopamine agonist treatment. Eur J Endocrinol. 2017; 176(3): 323–328.
- Peverelli E, Treppiedi D, Giardino E, et al. Dopamine and Somatostatin Analogues Resistance of Pituitary Tumors: Focus on Cytoskeleton Involvement. Front Endocrinol (Lausanne). 2015; 6: 187.
- Park SeH, Ku CR, Moon JuH, et al. Age- and Sex-Specific Differences as Predictors of Surgical Remission Among Patients With Acromegaly. J Clin Endocrinol Metab. 2018; 103(3): 909–916.
- Larkin S, Reddy R, Karavitaki N, et al. Granulation pattern, but not GSP or GHR mutation, is associated with clinical characteristics in somatostatin-naive patients with somatotroph adenomas. Eur J Endocrinol. 2013; 168(4): 491–499.
- Vargas G, Gonzalez B, Ramirez C, et al. Clinical characteristics and treatment outcome of 485 patients with nonfunctioning pituitary macroadenomas. Int J Endocrinol. 2015; 2015: 756069.
- Olsson DS, Bryngelsson IL, Ragnarsson O. Time trends of mortality in patients with non-functioning pituitary adenoma: a Swedish nationwide study. Pituitary. 2017; 20(2): 218–224.
- Asa SL, Ezzat S. Gonadotrope Tumors. Prog Mol Biol Transl Sci. 2016; 143: 187–210.
- Németh K, Darvasi O, Likó I, et al. Comprehensive analysis of circulating microRNAs in plasma of patients with pituitary adenomas. J Clin Endocrinol Metab. 2019 [Epub ahead of print].
- Greenman Y. Management of endocrine disease: Present and future perspectives for medical therapy of nonfunctioning pituitary adenomas. Eur J Endocrinol. 2017; 177(3): R113–R124.
- Erickson D, Scheithauer B, Atkinson J, et al. Silent subtype 3 pituitary adenoma: a clinicopathologic analysis of the Mayo Clinic experience. Clin Endocrinol (Oxf). 2009; 71(1): 92–99.
- Horvath E. Fine structural cytology and immunohistochemistry of the non-adenomatous pars distalis of the human pituitary. Pathol Res Pract. 1988; 183(5): 631–633.
- Asa SL, Casar-Borota O, Chanson P, et al. attendees of 14th Meeting of the International Pituitary Pathology Club, Annecy, France, November 2016. From pituitary adenoma to pituitary neuroendocrine tumor (PitNET): an International Pituitary Pathology Club proposal. Endocr Relat Cancer. 2017; 24(4): C5–C8.
- Kontogeorgos G, Thodou E. Double adenomas of the pituitary: an imaging, pathological, and clinical diagnostic challenge. Hormones (Athens). 2019; 18(3): 251–254.
- Ratliff JK, Oldfield EH. Multiple pituitary adenomas in Cushing's disease. J Neurosurg. 2000; 93(5): 753–761.
- Ciric I, Ragin A, Baumgartner C, et al. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery. 1997; 40(2): 225–36; discussion 236.
- Barker FG, Klibanski A, Swearingen B. Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab. 2003; 88(10): 4709–4719.
- Ahmed S, Elsheikh M, Stratton IM, et al. Outcome of transphenoidal surgery for acromegaly and its relationship to surgical experience. Clin Endocrinol (Oxf). 1999; 50(5): 561–567.
- Gittoes NJ, Sheppard MC, Johnson AP, et al. Outcome of surgery for acromegaly--the experience of a dedicated pituitary surgeon. QJM. 1999; 92(12): 741–745.
- Faustini-Fustini M, Pasquini E, Zoli M, et al. Pituitary centers of excellence. Neurosurgery. 2013; 73(3): E557.
- Schwartz TH. A role for centers of excellence in transsphenoidal surgery. World Neurosurg. 2013; 80(3-4): 270–271.
- Bates PR, Carson MN, Trainer PJ, et al. UK National Acromegaly Register Study Group (UKAR-2). Wide variation in surgical outcomes for acromegaly in the UK. Clin Endocrinol (Oxf). 2008; 68(1): 136–142.
- Melmed S, Colao A, Barkan A, et al. Acromegaly Consensus Group. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab. 2009; 94(5): 1509–1517.
