Contiguous Double Pituitary Adenomas Secreting the Same Hormones
Abstract views: 55
/ 
PDF downloads: 47
DOI:
https://doi.org/10.5281/zenodo.7771205Keywords:
double pituitary adenoma, transsphenoidal surgery, hormone, magnetic resonance imagingAbstract
The aim of this study is to investigate the importance of intraoperative observation in the diagnosis of the contiguous double pituitary adenomas secreting the same hormone which cannot be detected as double pituitary adenoma on (CE)-T1W1 magnetic resonance imaging.
400 patients with pituitary adenoma (PA) treated by transsphenoidal surgery (TSS) were investigated retrospectively.
During the operation, we saw that the PA consisted of two pieces of two different colors and hardness. Biopsies were taken from these two different regions.
Specimens were stained with hematoxylin and eosin staining (H&E). Each pathological section was subjected to immunohistochemical staining with an avidin biotin-peroxidase complex system.
The intensity values of both contrast enhancing and non-enhancing region of the PA and normal pituitary were measured on preoperative CE-T1W1 magnetic resonance imaging (MRI).Their clinical data and MRI findings were analyzed.
The CDPA secreting the same hormone was diagnosed in 6 patients. 4 (0,1%) patients had prolactinoma, 1 patient (0,25%) had CDPA secreting growth hormone ,1 patient (0,25%) had CDPA secreting ACTH. The prolactinomas were macroadenomas, the others were microadenomas.
Immunohistochemical staining of pathological samples taken from two different regions with different morphological features of the PA revealed that these cells were mainly positive for the same hormones.
The CDPA secreting the same hormone appeared as hypointense or hyperintences on (CE)-T1W1 MRI. The CDPA secreting the same hormone appeared as PA on (CE)-T1W1 MRI.
The CDPA secreting the same hormones is difficult to diagnosis as DPA on CE-T1W1 MRI. Intraoperative detection of color and consistency changes in different parts of the PA is very important in the diagnosis of the CDPA the secreting same hormone.
References
Andrioli M, Pecori Giraldi F, Losa M, Terreni M, Invitti C, Cavagnini F. Endocr J: Cushing's disease due to double pituitary ACTH-secreting adenomas: the first case report. Endocr J 2010;57:833-7.
Buurman H, Saeger W:Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data. Eur J Endocrinol2006;154:753–758.
Chanson P, Raverot G, Castinetti F, Cortet-Rudelli C, Galland F, Salenave S:Management of clinically non-functioning pituitary adenoma.Ann Endocrinol (Paris) 2015;76:239-47.
Cochran E J.Central Nervous System(2009) .In: Gattuso P, MD, Vijaya B. Reddy, MD, Odile David, MD, and Daniel J. Spitz, MD(eds).Differential Diagnosis in Surgical Pathology, Saunders, Philadelphia, pp1028-1030.
Famini P, Maya MM, Melmed S:Pituitary magnetic resonance imaging for sellar and parasellar masses: ten-year experience in 2598 patients. J Clin Endocrinol Metab 2011;96:1633-41.
Iacovazzo D, Bianchi A, Lugli F, Milardi D, Giampietro A, Lucci-Cordisco E, Doglietto F, Lauriola L, De Marinis L:Double pituitary adenomas. Endocrine 2013;43: 452-7.
Karavitaki N :Prevalence and incidence of pituitary adenomas. Ann Endocrinol (Paris)2012;73: 79-80.
Kim K, Yamada S, Usui M, Sano T:Preoperative identification of clearly separated double pituitary adenomas. Clin Endocrinol (Oxf)2004; 61: 26–30.
Kontogeorgos G, Kovacs K , Horvath E , Scheithauer BW Multiple adenomas of the human pituitary. A retrospective autopsy study with clinical implications. J Neurosurg 1991; 74:243–247.
Kontogeorgos G, Scheithauer BW, Horvath E, Kovacs K, Lloyd RV, Smyth HS, Rologis D:Double adenomas of the pituitary: a clinicopathological study of 11 tumors. Neurosurgery 1992;31: 840–849.
Larkin S, Reddy R, Karavitaki N, Cudlip S, Wass J, Ansorge O:Granulation pattern, but not GSP or GHR mutation, is associated with clinical characteristics in somatostatin-naive patients with somatotroph adenomas. Eur J Endocrinol.2013;168:491-9.
Luk CT, Magri F, Villa C, Locatelli D, Scagnelli P, Lagonigro MS, et al. Prevalence of double pituitary adenomas in a surgical series: Clinical, histological and genetic features. J Endocrinol Invest 2010;33: 325-31.
Magri F, Villa C, Locatelli D, Scagnelli P, Lagonigro MS, Morbini P, Castellano M, Gabellieri E, Rotondi M, Solcia E, Daly AF:Prevalence of double pituitary adenomas in a surgical series: Clinical, histological and genetic features. Acta Neurochir (Wien)2014;156:141-6.
Mehta GU, Montgomery BK, Raghavan P, Sharma S, Nieman LK, Patronas N, Oldfield EH, Chittiboina P:Different imaging characteristics of concurrent pituitary adenomas in a patient with Cushing's disease. J Clin Neurosci. 2015; 22(5):891-4.
Meij BP, Lopes MB, Vance ML, Thorner MO, Laws ER Jr:Double pituitary lesions in three patients with Cushing's disease. Pituitary 2000;3: 159-68.
Mendola M, Dolci A, Piscopello L, Tomei G, Bauer D, Corbetta S, Ambrosi B:Rare case of Cushing's disease due to double ACTH-producing adenomas, one located in the pituitary gland and one into the stalk. Hormones (Athens)2014;13: 574-8.
Monteith SJ, Starke RM, Jane JA Jr, Oldfield EH:Use of the histological pseudocapsule in surgery for Cushing disease: rapid postoperative cortisol decline predicting complete tumor resection. J Neurosurg 2012;116:721-7.
Oldfield EH, Vortmeyer AO.: Development of a histological pseudocapsule and its use as a surgical capsule in the excision of pituitary tumors. JNeurosurg 2006;104:7-19.
Ouyang T, Rothfus WE, Ng JM, Challinor SM:Imaging of the pituitary.Radiol Clin North Am 2011;49: 549-71.
Rasul FT, Jaunmuktane Z, Khan AA, Phadke R, Powell M:Plurihormonal pituitary adenoma with concomitant adrenocorticotropic hormone (ACTH) and growth hormone (GH) secretion: a report of two cases and review of the literature.ActaNeurochir(Wien) 2014;156:141-146.
Ratliff JK, Oldfield EH:Multiple pituitary adenomas in Cushing’s disease. J Neurosurg2000;93: 753–761.
Rennert J, Doerfler A:Imaging of sellar and parasellar lesions. Clin Neurol Neurosurg 2007;109:111–124.
Rosai A, LaurenV, Ivan.N, Marin.M.(1993). Rozai and Ackerman’s Surgical Patholody.Vol:2.Elsevier,Mosby, Edinburg,London, Newyork,Philadelphia,StLouis,Sydney,Toronto, pp2446-2459.
Sano T, Horiguchi H, Xu B, Li C, Hino A, Sakaki M, Kannuki S, Yamada S:Double pituitary adenomas: six surgical cases. Pituitary 1999;1: 243–250.
Scheithauer BW, Horvath E, Kovacs K, Laws ER, Jr, Randall RV, Ryan N:Plurihormonal pituitary adenomas. Semin Diagn Pathol.1986;3:69.
Steiner E, Knosp E, Herold CJ, Kramer J, Stiglbauer R, Staniszewski K, Imhof H:Pituitary adenomas: findings of postoperative MR imaging. Radiology 1992;185:521-7.
Tabarin A, Laurent F, Catargi B, Olivier-Puel F, Lescene R, Berge J, Galli FS, Drouillard J, Roger P, Guerin J.:Comparative evaluation of conventional and dynamic magnetic resonance imaging of the pituitary gland for the diagnosis of Cushing's disease. Clin Endocrinol (Oxf)1998;49: 293–300.
Terano T, Fujii R:Nonfunctioning pituitary tumor- subunit, inactive hormone producing tumor. Nihon Rinsho 1993;51: 2696-700.
Thodou E, Kontogeorgos G, Horvath E, Kovacs K, Smyth HS, Ezzat S:Asynchronous pituitary adenomas with differing morphology. Arch Pathol Lab Med 1995;119:748-50.
Trouillas J, Roy P, Sturm N, Dantony E, Cortet-Rudelli C, et al. A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathol 1993;126:123-35.
Sathyakumar R, Chacko G. Newer Concepts in Classification Neurol India. 2020 May-Jun;68(Supplement):S7-S12.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Euroasia Journal of Mathematics, Engineering, Natural & Medical Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The journal is licensed under a 