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Pituitary

, Volume 21, Issue 2, pp 217–229 | Cite as

Malignant transformation in non-functioning pituitary adenomas (pituitary carcinoma)

  • Nèle Lenders
  • Ann McCormack
Article

Abstract

Non-functioning pituitary carcinomas (NFPC) are defined as tumours of adenophyseal origin with craniospinal or systemic dissemination, with the absence of a hormonal hypersecretion syndrome. These are a histologically heterogenous group of tumours, comprising gonadotroph, null cell, “silent” tumours of corticotroph, somatotroph or lactotroph cell lineages as well as plurihormonal Pit-1 tumours. NFPC are exceedingly rare, and hence few cases have been described. This review has identified 38 patients with NFPC reported in the literature. Recurrent invasive non-functioning pituitary adenomas (NFPA) were observed in a majority of patients. Various factors have been identified as markers of the potential for aggressive behaviour, including rapid tumour growth, growth after radiotherapy, gain or shift of hormone secretion and raised proliferative markers. Typically, there is a latency of several years from the original presentation with an NFPA to identification of metastases and only 5 cases reported with rapidly progressive malignant disease within 1 month of presentation. Therapeutic options include debulking surgery, radiation therapy and chemotherapy with temozolomide recommended as first line systemic treatment. Although long-term survivors are described, prognosis remains generally very poor (median survival 8 months). Improvements in molecular tumour profiling may assist in predicting tumour behaviour, guide therapeutic choices and identify novel therapies.

Keywords

Pituitary carcinomas Non-functioning pituitary adenomas Aggressive pituitary tumours Metastases Temozolomide 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Garvan Institute of Medical ResearchSydneyAustralia
  2. 2.Department of Endocrinology, St Vincent’s HospitalUniversity of New South WalesSydneyAustralia
  3. 3.Royal Brisbane and Women’s HospitalBrisbaneAustralia

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