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Double adenomas of the pituitary: an imaging, pathological, and clinical diagnostic challenge

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Abstract

Double and multiple adenomas of the pituitary are composed of two or more distinct tumors located in the same gland. They represent uncommon lesions measuring less than 1 cm, reported as having a low incidence in autopsies and occurring even more infrequently in surgical series. The histological diagnosis of double adenomas in surgical material is often extremely difficult, and confirmation requires immunohistochemistry and, occasionally, electron microscopy. Fragmented tissue material submitted for histology after transsphenoidal resection complicates the diagnosis. Difficulties in demonstrating double or multiple adenomas by imaging techniques contribute to diagnostic failure. Magnetic resonance imaging (MRI) techniques may disclose two separate adenomas located in the same pituitary gland. Intraoperative MRI and imaging ultrasonography, together with positron emission computed tomography, more accurately identify sites of residual tumors. These techniques might also detect postoperatively a residual tumor belonging to the second component of double adenoma. Double adenomas may also create extreme clinical diagnostic challenges. It is almost impossible to suspect functioning double adenomas with combined hormone secretion, each one secreting a different hormone, and distinguish them from an isolated plurihormonal adenoma, simultaneously secreting more than one hormone. Double adenomas may underlie surgical failure when one adenoma is removed while the other is left behind. Despite the low frequency of double adenomas, identification and resection of both of them is of major importance for the achievement of biochemical cure.

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References

  1. Kontogeorgos G, Kovacs K, Horvath E, Scheithauer BW (1991) Multiple adenomas of the human pituitary. A retrospective autopsy study with clinical implications. J Neurosurg 74(2):243–247. https://doi.org/10.3171/jns.1991.74.2.0243

    Article  CAS  PubMed  Google Scholar 

  2. Kontogeorgos G, Scheithauer BW, Horvath E, Kovacs K, Lloyd RV, Smyth HS, Rologis D (1992) Double adenomas of the pituitary: a clinicopathological study of 11 tumors. Neurosurgery 31(5):840–849, discussion 849. https://doi.org/10.1227/00006123-199211000-00003

    Article  CAS  PubMed  Google Scholar 

  3. Yoshida A, Sen C, Asa SL, Rosenblum MK (2008) Composite pituitary adenoma and craniopharyngioma?: an unusual sellar neoplasm with divergent differentiation. Am J Surg Pathol 32(11):1736–1741. https://doi.org/10.1097/PAS.0b013e3181753abd

    Article  PubMed  Google Scholar 

  4. Koutourousiou M, Kontogeorgos G, Wesseling P, Grotenhuis AJ, Seretis A (2010) Collision sellar lesions: experience with eight cases and review of the literature. Pituitary 13(1):8–17. https://doi.org/10.1007/s11102-009-0190-2

    Article  PubMed  Google Scholar 

  5. Mendola M, Dolci A, Piscopello L, Tomei G, Bauer D, Corbetta S, Ambrosi B (2014) Rare case of Cushing’s disease due to double ACTH-producing adenomas, one located in the pituitary gland and one into the stalk. Hormones 13(4):574–578. https://doi.org/10.14310/horm.2002.1503

    Article  PubMed  Google Scholar 

  6. Thodou E, Kontogeorgos G, Horvath E, Kovacs K, Smyth HS, Ezzat S (1995) Asynchronous pituitary adenomas with differing morphology. Arch Pathol Lab Med 119(8):748–750

    CAS  PubMed  Google Scholar 

  7. Budan RM, Georgescu CE (2016) Multiple pituitary adenomas: a systematic review. Front Endocrinol (Lausanne) 1(7):1–8. https://doi.org/10.3389/fendo.2016.00001

    Article  Google Scholar 

  8. Kontogeorgos G, Kovacs K, Lloyd RV, Righi A (2017) Plurihormonal and double adenomas. In: Lloyd RV, Osamura RY, Klöppel G, Rosai J (eds) WHO classification of tumours of endocrine organs, 4th end. IACR, Lyon pp 39–40

  9. Ratliff JK, Oldfield EH (2000) Multiple pituitary adenomas in Cushing’s disease. J Neurosurg 93(5):753–761. https://doi.org/10.3171/jns.2000.93.5.0753

    Article  CAS  PubMed  Google Scholar 

  10. Gorczyca W, Hardy J (1988) Microadenomas of the human pituitary and their vascularization. Neurosurgery 22(1 Pt 1):1–6. https://doi.org/10.1227/00006123-198801010-00001

    Article  CAS  PubMed  Google Scholar 

  11. Pantelia E, Kontogeorgos G, Piaditis G, Rologis D (1998) Triple pituitary adenoma in Cushing’s disease: case report. Acta Neurochir 140(2):190–193

    Article  CAS  PubMed  Google Scholar 

  12. Jastania RA, Alsaad KO, Al-Shraim M, Kovacs K, Asa SL (2005) Double adenomas of the pituitary: transcription factors Pit-1, T-pit, and SF-1 identify cytogenesis and differentiation. Endocr Pathol 16(3):187–194

    Article  CAS  PubMed  Google Scholar 

  13. Osamura RY, Grossman A, Korbonits M, Kovacs K, Lopes BMS, Masturo A, Troullas J (2017) Pituitary adenoma. In: Lloyd RV, Osamura RY, Klöppel G, Rosai J (eds) WHO classification of tumours of endocrine organs, 4th end. IACR, Lyon pp 14-18

  14. Kannuki S, Matsumoto K, Sano T, Shintani Y, Bando H, Saito S (1996) Double pituitary adenoma–two case reports. Neurol Med Chir (Tokyo) 36:818–821. https://doi.org/10.2176/nmc.36.818

    Article  CAS  Google Scholar 

  15. Kim K, Yamada S, Usui M, Sano T (2004) Preoperative identification of clearly separated double pituitary adenomas. Clin Endocrinol (Oxf) 61(1):26–30. https://doi.org/10.1111/j.1365-2265.2004.02055.x

    Article  Google Scholar 

  16. Johnsen DE, Woodruff WW, Allen IS, Cera PJ, Funkhouser GR, Coleman LL (1991) MR imaging of the sellar and juxtasellar regions. Radiographics 11(5):727–758. https://doi.org/10.1148/radiographics.11.5.1947311

    Article  CAS  PubMed  Google Scholar 

  17. Pu J, Wang Z, Zhou H, Zhong A, Jin K, Ruan L, Yang G (2016) Oncol Lett 12(1):585–590. https://doi.org/10.3892/ol.2016.4673

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Miyagi N, Doi R, Kuramoto T, Sakata K, Tahara S, Sugita Y, Morioka M (2018) Double pituitary adenomas associated with persistent trigeminal artery: a rare case report and the review of literature. Neurosurg Rev 41(1):341–345. https://doi.org/10.1007/s10143-017-0924-y

    Article  PubMed  Google Scholar 

  19. Kremer P, Forsting M, Ranaei G, Wüster C, Hamer J, Sartor K, Kunze S (2002) Magnetic resonance imaging after transsphenoidal surgery of clinically non-functional pituitary macroadenomas and its impact on detecting residual adenoma. Acta Neurochir 144(5):433–443. https://doi.org/10.1007/s007010200064

    Article  CAS  PubMed  Google Scholar 

  20. Paterno V, Fahlbusch R (2014) High-filed iMRI in transsphenoidal pituitary adenoma surgery with special respect to typical localization of residual tumor. Acta Neurochir 156(3):463–474. https://doi.org/10.1007/s00701-013-1978-4

    Article  PubMed  Google Scholar 

  21. Knappe UJ, Engelbach M, Konz K, Lakomek HJ, Saeger W, Schonmayr R, Mann WA (2011) Ultrasound-assisted microsurgery for Cushing’s disease. Exp Clin Endocrinol Diabetes 119(4):191–200. https://doi.org/10.1055/s-0029-1241207

    Article  CAS  PubMed  Google Scholar 

  22. Koulouri O, Kandasamy N, Hoole AC et al (2016) Eur J Endocrinol 175(5):485–498. https://doi.org/10.1530/EJE-16-0639

    Article  CAS  PubMed  Google Scholar 

  23. Tolis G, Bertrand G, Carpenter S, McKenzie JM (1978) Acromegaly and galactorrhea-amenorrhea with two pituitary adenomas secreting growth hormone or prolactin. A case report. Ann Intern Med 89(3):345–348. https://doi.org/10.7326/0003-4819-89-3-345

    Article  CAS  PubMed  Google Scholar 

  24. Sano T, Horiguchi H, Xu B, Li C, Hino A, Sakaki M, Kannuki S, Yamada S (1999) Double pituitary adenomas: six surgical cases. Pituitary 1:243–250

    Article  CAS  PubMed  Google Scholar 

  25. Ogando-Rivas E, Alalade AF, Boatey J, Schwartz TH (2017) Pituitary 20(6):702–708. https://doi.org/10.1007/s11102-017-0826-6

    Article  CAS  PubMed  Google Scholar 

  26. McKelvie PA, McNeill P (2002) Double pituitary adenomas: a series of three patients. Pathology 34:57–60

    Article  PubMed  Google Scholar 

  27. Meij BP, Lopes MB, Vance ML, Thorner MO, Laws ER Jr (2000) Double pituitary lesions in three patients with Cushing’s disease. Pituitary 3(3):159–168

    Article  CAS  PubMed  Google Scholar 

  28. Mazarakis N, Kontogeorgos G, Kovacs K, Horvath E, Borboli N, Piaditis G (2001) Pituitary 4(4):215–221

    Article  CAS  PubMed  Google Scholar 

  29. Buurman H, Saeger W (2006) Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data. Europ J Endocrinol 154(5):753–758. https://doi.org/10.1530/eje.1.02107

    Article  CAS  Google Scholar 

  30. Kontogeorgos G, Thodou E (2016) The gonadotroph origin of null cell adenomas. Hormones 15(2):243–247. https://doi.org/10.14310/horm.2002.1652

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Authors and Affiliations

  1. Department of Pathophysiology, University of Athens, Athens, Greece

    George Kontogeorgos

  2. Department of Pathology, University of Thessaly, Larissa, Greece

    Eleni Thodou

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  1. George Kontogeorgos
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  2. Eleni Thodou
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Kontogeorgos, G., Thodou, E. Double adenomas of the pituitary: an imaging, pathological, and clinical diagnostic challenge. Hormones 18, 251–254 (2019). https://doi.org/10.1007/s42000-019-00126-4

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