Skip to main content
SpringerLink
Log in

Tumors in the Adenohypophysis

  • Chapter
  • First Online:
Endocrine Pathology:

Abstract

The human pituitary gland is located in the sella turcica and consits of the adenohypophysis and the neurohypophysis. The adenohypophysis, comprising approximately 80% of the entire pituitary gland, produces six hormones, including growth hormone (GH), prolactin (PRL), and adrenocorticotropin (ACTH) – as well as the three glycoprotein hormones – thyrotropin or thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH). Tumors of the pituitary gland are classified based on the five-tier cassification scheme that is now embodied in the World Health Organization classification of tumors. Clinical, endocrine, imaging, and operative as well as histological findings all contribute to the current classification of these tumors. Ultrastructural study of pituitary tumors is also important in their classification. In this chapter, we discuss morphological characteristics of pituitary tumor subtypes including GH-, PRL-, ACTH-, TSH-, FSH/LH-producing adenomas, as well as silent and null cell adenomas and pituitary carcinomas.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Horvath E, Scheithauer BW, Kovacs K, Lloyd RV (2001) Hypothalamus and pituitary. In: Graham DI, Lantos PL (eds) Greenfield’s neuropathology, 7th edn. Arnold, London, pp 983–1062

    Google Scholar 

  2. Horvath E, Kovacs K, Josse R (1983) Pituitary corticotroph cell adenoma with marked abundance of microfilaments. Ultrastruct Pathol 5:249–255

    Article  CAS  PubMed  Google Scholar 

  3. Yamada S (2001) Epidemiology of pituitary tumors. In: Thapar K, Kovacs L, Scheithauer BW, Lloyd RV (eds) Diagnosis and management of pituitary tumors. Humana Press, Totowa, NJ, pp 57–69

    Google Scholar 

  4. Scheithauer BW, Kurtkaya-Yapicier O, Kovacs KT, Young WF Jr, Lloyd RV (2005) Pituitary carcinoma: a clinicopathological review. Neurosurgery 56:1066–1074

    PubMed  Google Scholar 

  5. Lopes MB, Scheithauer BW, Schiff D (2005) Pituitary carcinoma: diagnosis and treatment. Endocrine 28(1):115–121

    Article  CAS  PubMed  Google Scholar 

  6. Ragel BT, Couldwell WT (2004) Pituitary carcinoma: a review of the literature. Neurosurg Focus 16:E7

    Article  PubMed  Google Scholar 

  7. Saeger W, Lubke D (1996) Pituitary carcinomas. Endoc Pathol 7:21–35

    Article  CAS  Google Scholar 

  8. Kovacs K (2006) The 2004 Who classification of pituitary tumors: comments. Acta Neuropathologica 111:62–63

    Article  PubMed  Google Scholar 

  9. DeLellis RA, Lloyd RV, Heitz PU, Eng C (2004) The adenohypophysis. In: DeLellis RA, Lloyd RV, Heitz PU, Eng C (eds) The World Health Organization classification of endocrine tumors, pathology and genetics of tumors of endocrine organs. IARC, Lyons, pp 9–15

    Google Scholar 

  10. Saeger W, Ludecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ et al (2007) Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol 156:203–216

    Article  CAS  PubMed  Google Scholar 

  11. Tien RD (1992) Sequence of enhancement of various portions of the pituitary gland on gadolinium-enhanced MR images: correlation with regional blood supply. Am J Roentgenol 158:651–654

    CAS  Google Scholar 

  12. Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, Stalla GK, Ghigo E (2007) Hypopituitarism. Lancet 369:1461–1470

    Article  CAS  PubMed  Google Scholar 

  13. Agha A, Thompson CJ (2006) Anterior pituitary dysfunction following traumatic brain injury (TBI). Clin Endocrinol (Oxf) 64:481–488

    Article  Google Scholar 

  14. Hardy J (1969) Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 16:185–217

    CAS  PubMed  Google Scholar 

  15. Kovacs K, Horvath E (2001) The differential diagnosis of lesions involving the sella turcica. Endocr Pathol 12:389–395

    Article  CAS  PubMed  Google Scholar 

  16. Kovacs K, Horvath W (1986) Tumors of the pituitary gland. In: Atlas of tumor pathology (Second Series, Fascicle 21), Armed Forces Institute of Pathology, Washington, DC, pp 1–264

    Google Scholar 

  17. Asa SL (2008) Practical pituitary pathology: what does the pathologist need to know? Arch Path Lab Med 132:1231–1240

    PubMed  Google Scholar 

  18. Horvath E, Kovacs K (1998) The adenohypophysis. In: Kovacs K, Asa SL (eds) Functional endocrine pathology, 2nd edn. Blackwell Science, Malden, pp 247–281

    Google Scholar 

  19. Al-Gahtany M, Horvath E, Kovacs K (2003) Pituitary hyperplasia. Hormones (Athens) 2:149–158

    Google Scholar 

  20. Horvath E, Kovacs K (1993) Ultrastructural diagnosis of pituitary adenomas and hyperplasia’s. In: Lloyd RV (ed) Surgical pathology of the pituitary gland. Major problems in pathology. Saunders, Philadelphia, PA, pp 52–84

    Google Scholar 

  21. Kontogeorgos G (2005) Classification and pathology of pituitary tumors. Endocrine 28:27–35

    Article  CAS  PubMed  Google Scholar 

  22. Hovath E, Kovacs K (1992) Ultrastructural diagnosis of human pituitary adenomas. Micros Res Tech 20:107–135

    Article  Google Scholar 

  23. Horvath E (1994) Ultrastructural markers in the pathologic diagnosis of pituitary adenomas. Ultrastruct Pathol 18:171–179

    Article  CAS  PubMed  Google Scholar 

  24. Horvath E, Kovacs K (2006) Pathology of acromegaly. Neuroendocrinology 83:161–165

    Article  CAS  PubMed  Google Scholar 

  25. Bhayana S, Booth GL, Asa SL, Kovacs K, Ezzat S (2005) The implication of somatotroph adenoma phenotype to somatostatin analog responsiveness in acromegaly. J Clin Endocrinol Metab 90:6290–6295

    Article  CAS  PubMed  Google Scholar 

  26. Obari A, Sano T, Ohyama K, Kudo E, Qian ZR et al (2008) Clinicopathological features of growth hormone-producing pituitary adenomas: difference among various types defined by cytokeratin distribution pattern including a transitional form. Endocr Pathol 19:82–91

    Article  PubMed  Google Scholar 

  27. Horvath E, Kovacs K (1986) Pathology of prolactin cell adenomas of the human pituitary. Semin Diagn Pathol 3:4–17

    CAS  PubMed  Google Scholar 

  28. Robert F, Hardy J (1986) Human corticotroph cell adenomas. Semin Diagn Pathol 3:34–41

    CAS  PubMed  Google Scholar 

  29. Crooke A (1935) A change in the basophil cells of the pituitary gland common to conditions which exhibit the syndrome attributed to basophil adenoma. J Pathol Bacteriol 41:339–349

    Article  Google Scholar 

  30. Neumann PE, Horoupian DS, Goldman JE, Hess MA (1984) Cytoplasmic filaments of Crooke’s hyaline change belong to the cytokeratin class. An immunocytochemical and ultrastructural strudy. Am J Pathol 116:214–222

    CAS  PubMed  Google Scholar 

  31. Girod C, Troullas J, Clasutrat B (1986) The human thyrotropic adenoma: pathologic diagnosis in five cases and critical review of the literature. Semin Diag Pathol 3:58–68

    CAS  Google Scholar 

  32. Beck-Peccoz P, Piscitelli G, Amr S et al (1986) Endocrine, biochemical, and morphological studies of a pituitary adenoma secreting growthhormone, thyrotropin (TSH), and alpha-subunit:evidence of secretion of TSH with increased bioactivity. J Clin Endocrinol Metab 62:704–711

    Article  CAS  PubMed  Google Scholar 

  33. Clarke MJ, Erickson D, Castro MR, Atkinson JL (2008) Thyroid-stimulating hormone pituitary adenomas. J Neurosurg 109:17–22

    Article  PubMed  Google Scholar 

  34. Horvath E, Kovacs K (1984) Gonadotroph adenomas of the human pituitary: sex-related fine-structural dichotomy. A histologic, immunocytochemical, and electron-microscopic study of 30 tumors. Am J Pathol 117:429–440

    CAS  PubMed  Google Scholar 

  35. Kontogeorgos G, Horvath E, Kovacs K (1990) Sex-linked ultrastructural dichotomy of gonadotroph adenomas of the human pituitary: an electron microscopic analysis of 145 tumors. Ultrastruct Pathol 14:475–482

    Article  CAS  PubMed  Google Scholar 

  36. Scheithauer BW, Jaap AJ, Horvath E et al (2000) Clinically silent corticotroph tumors of the pituitary gland. Neurosurgery 47:723–729

    Article  CAS  PubMed  Google Scholar 

  37. Horvath E, Kovacsk K, Killinger DW, Smyth HS, Platts ME, Singer W (1980) Silent corticotroph adenomas of the human pituitary gland: a histologic, immunocytologic, and ultrastructural stdudy. Am J Pathol 98:617–638

    CAS  PubMed  Google Scholar 

  38. Qian X, Scheithauer BW, Kovacs K, Lloyd RV (2005) DNA microarrays: recent developments and applications to the study of pituitary tissues. Endocrine 28:49–56

    Article  CAS  PubMed  Google Scholar 

  39. Lloyd RV (2004) Advances in pituitary pathology: use of novel techniques. Front Horm Res 32:146–174

    Article  CAS  PubMed  Google Scholar 

  40. Vlotides G, Eigler T, Melmed S (2007) Pituitary tumor-transforming gene: physiology and implications for tumorigenesis. Endocr Rev 28:165–186

    Article  CAS  PubMed  Google Scholar 

  41. Alexander JM, Biller BM, Bikkal H, Zervas NT, Arnold A, Klibanski A (1990) Clinially nonfunctioning pituitary tumors are monoclonal in origin. J Clin Invest 86:336–340

    Article  CAS  PubMed  Google Scholar 

  42. Schulte HM, Oldfield EH, Allolio B, Katz DA, Berkman RA, Ali IU (1991) Clonal composition of pituitary adenomas in patients with Csushing’s disease: determination by X-chromosome inactivation analysis. J Clin Endocrinol Metab 773:1302–1308

    Article  Google Scholar 

  43. Frohman LA, Kineman RD (2002) Growth hormone-releasing hormone and pituitary development, hyperplasia and tumorigenesis. Trends Endocrinol Metab. 13:299–303

    Article  CAS  PubMed  Google Scholar 

  44. Othman NH, Ezzat S, Kovacs K, Horvath E, Poulin E, Smyth HS, Asa SL (2001) Growth hormone-releasing hormone (GHRH) and GHRH receptor (GHRH-R) isoform expression in ectopic acromegaly. Clin Endocrinol (Oxf) 55:135–140

    Article  CAS  Google Scholar 

  45. Sano T, Asa SL, Kovacs K (1988) Growth horomone-releasing horomone-producing tumors: clinical, biochemical, and morphological manifestations. Endocr Rev 9:357–373

    Article  CAS  PubMed  Google Scholar 

  46. Asa SL, Kovacs K, Stefaneanu L et al (1992) Pituitary adenomas in mice transgenic for growth hormone-releasing hormone. Endocrinology 131:2083–2089

    Article  CAS  PubMed  Google Scholar 

  47. Asa SL, Kelly MA, Grandy DK, Low MJ (2001) Pituitary lactotroph adenomas develop after prolonged lactotroph hyperplasia in dopamine D2 receptor-deficient mice. Endocrinology 145:543–559

    Google Scholar 

  48. Goth MI, Makara GB, Gerandi I (2001) Hypothalamic-pituitary physiology and regulation. In: Thapar K, Kovacs K, Scheithauer BW, Lloyd RV (eds) DIagnsis and management of pituitary tumors. Humana Press, Totowa, NJ, pp 41–55

    Google Scholar 

  49. Lania AG, Mantovani G, Spada A (2006) Mechanisms of disease: Mutations of G proteins and G-protein-coupled receptors in endocrine diseases. Nat Clin Pract Endocrinol Metab 2:681–693

    Article  CAS  PubMed  Google Scholar 

  50. Donangelo I, Melmed S (2005) Pathophysiology of pituitary adenomas. J Endocrinol Invest 28:100–105

    CAS  PubMed  Google Scholar 

  51. Horvath A, Stratakis CA (2008) Clinical and molecular genetics of acromegaly: MEN1, Carney complex, McCune-Albright syndrome, familial acromegaly and genetic defects in sporadic tumors. Rev Endocr Metab Disord 9:1–11

    Article  CAS  PubMed  Google Scholar 

  52. Scheithauer BW, Horvath E, Kovacs K, Laws ER Jr, Randall RV, Ryan N (1986) Plurihormonal pituitary adenomas. Semin Diagn Pathol 3:69–82

    CAS  PubMed  Google Scholar 

  53. Matsuno A, Sasaki T, Kirino T (1999) Plurihormonal pituitary tumor. J Neurosurg 90:608–609

    CAS  PubMed  Google Scholar 

  54. Gleiberman ZhuX, Rosenfeld MG AS (2007) Molecular physiology of pituitary development: signaling and transcriptional networks. Physiol Rev 87:933–963

    Article  PubMed  Google Scholar 

  55. Asa SL, Ezzat S (2004) Molecular basis of pituitary development and cytogenesis. Front Horm Res 32:1–19

    Article  CAS  PubMed  Google Scholar 

  56. Kovacs K, Horvath E, Stefaneanu L et al (1998) Pituitary adenoma producing hormone and adrenocorticotropin: a histological, immunocytochemical, electron microscopic, and in situ hybridization study. Case report. J Neurosurg 88:1111–1115

    Article  CAS  PubMed  Google Scholar 

  57. Vidal S, Syro L, Horvath E, Uribe H, Kovacs K (1999) Ultrastructural and immunoelectron microscopic study of three unusual plurihormonal pituitary adenomas. Ultrastruct Pathol 23:141–148

    Article  CAS  PubMed  Google Scholar 

  58. Vidal S, Horvath E, Kovacs K, Cohen SM, Lloyd RV, Scheithauer BW (2000) Transdifferentiation of somatotrophs to thyrotrophs in the pituitary of patients with protracted primary hypothyroidism. Virchows Arch 436:43–51

    Article  CAS  PubMed  Google Scholar 

  59. Vidal S, Horvath E, Kovacs K, Lloyd RV, Smyth HS (2001) Reversible transdifferentiation: interconversion of somatotrophs and lactotrophs inpituitary hyperplasia. Mod Pathol 14:20–28

    Article  CAS  PubMed  Google Scholar 

  60. Felix I, Asa SL, Kovacs K, Horvath E, Smyth HS (1994) Recurrent plurihormonal bimorphous pituitary adenoma producing growth horomone, thyrotropin, and prolactin. Arch Pathol Lab Med 118:66–70

    CAS  PubMed  Google Scholar 

  61. Horvath E, Kovacs K, Scheithauer BW et al (1983) Pituitary adenomas producing growth hormone, prolactin, and one or more glycoprotein hormones: a histologic, immunohistochemica, and ultrastructural study of four surgically removed tumors. Ultrastruct Pathol 5:171–183

    Article  CAS  PubMed  Google Scholar 

  62. Horvath E, Kovacs K, Singer W et al (1981) Acidophil stem cell adenoma of the human pituitary’: clinicopathologic analysis of 15 cases. Cancer 47:761–771

    Article  CAS  PubMed  Google Scholar 

  63. Thapar K, Kovacs K, Scheithauer BW et al (1996) Proliferative activity and invasiveness among pituitary adenomas and carcinomas: an analysis using the MIB-1 antibody. Neurosurgery 38:99–106

    Article  CAS  PubMed  Google Scholar 

  64. Lloyd RV, Jin L, Qian X, Kulig E (1997) Aberrant p27kip1 expression in endocrine and other tumors. Am J Pathol 150:401–407

    CAS  PubMed  Google Scholar 

  65. Turner HE, Nagy Z, Sullivan N, Esiri MM, Wass JA (2000) Expression analysis of cyclins in pituitary adenomas and the normal pituitary gland. Clin Endocrinol (Oxf) 53:337–344

    Article  CAS  Google Scholar 

  66. Kovacs K, Scheithauer BW, Lombardero M, McLendon RE, Syro LV, Uribe H, Ortiz LD, Penagos LC (2008) MGMT immunoexpression predicts responsiveness of pituitary tumors to temozolomide therapy. Acta Neuropathol 115:261–262

    Article  PubMed  Google Scholar 

  67. Horvath E, Kovacs K, Lloyd RV (1999) Pars itermedia of the human pituitary revisited: morphologic aspects and frequency of hyperplasia of POMC-peptide immunoreactive cells. Endocr Pathol 10:55–64

    Article  Google Scholar 

  68. Herman V, Fagin J, Gonsky R, Kovacs K, Melmed S (1990) Clonal origin of pituitary adenomas. J Clin Endocrinol Metab 71:1427–1433

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Laboratory Medicine, Division of Pathology, St. Michael’s Hospital, Toronto, ON, Canada

    Fateme Salehi

Authors
  1. Fateme Salehi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sergio Vidal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eva Horvath
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kalman Kovacs
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernd W. Scheithauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fateme Salehi .

Editor information

Editors and Affiliations

  1. Dept. Laboratory Medicine & Pathology, Mayo Clinic, First Street SW 200, Rochester, 55905, U.S.A.

    Ricardo V. Lloyd

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Salehi, F., Vidal, S., Horvath, E., Kovacs, K., Scheithauer, B.W. (2010). Tumors in the Adenohypophysis. In: Lloyd, R. (eds) Endocrine Pathology:. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1069-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-1069-1_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1068-4

  • Online ISBN: 978-1-4419-1069-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation