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Epidemiology of common and uncommon adult pituitary tumors in the U.S. according to the 2017 World Health Organization classification



To examine the contemporary epidemiology of adult pituitary tumors with a particular focus on uncommon tumor types, using the 2017 WHO Classification of pituitary tumors.


Adult patients presenting with a pituitary or sellar tumor between 2004 and 2017 were identified from the U.S. National Cancer Database, with tumor type categorized according to the 2017 WHO classification. Descriptive epidemiological statistics were evaluated and reported for all pituitary tumor types and subtypes.


113,349 adults with pituitary tumors were identified, 53.0% of whom were female. The majority of pituitary tumors were pituitary adenomas (94.0%), followed by craniopharyngiomas (3.8%). Among pituitary adenomas, whereas 71.6% of microadenomas presented in females, only 46.7% of macroadenomas and 41.3% of giant adenomas did (p < 0.001). For craniopharyngiomas, 71.2% were adamantinomatous and 28.8% were papillary, with adamantinomatous tumors associated with Black non-Hispanic race/ethnicity (ORadj = 2.44 vs. White non-Hispanic, 99.9 %CI = 1.25–4.75, p < 0.001) in multivariable analysis. The remaining 0.7% (n = 676) of pathology-confirmed pituitary tumor types were composed of: 21% tumors of the posterior pituitary, 16% chordomas, 11% pituitary carcinomas (i.e. adenohypophyseal histology with metastasis; herein most frequently to bone), 10% meningiomas, 8% germ cell tumors, 7% hematolymphoid (largely DLBCLs), and 4% neuronal/paraneuronal (largely gangliogliomas). Pituitary carcinomas and posterior pituitary tumors demonstrated a male predilection (62.2% and 56.0%, respectively), whereas sellar meningiomas predominated in females (84.1%). Age, race/ethnicity, tumor size, and overall survival further varied across uncommon pituitary tumor types.


Our findings provide a detailed contemporary dissection of the epidemiology of common and uncommon adult pituitary tumors in the context of WHO2017.

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Data availability

The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. Data available by NCDB application.

Code availability

Not applicable.


  1. 1.

    Melmed S (2020) Pituitary-tumor endocrinopathies. N Engl J Med 382:937–950.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Melmed S (2011) Pathogenesis of pituitary tumors. Nat Rev Endocrinol 7:257–266.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Ostrom QT, Patil N, Cioffi G et al (2020) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2013–2017. Neuro-Oncol 22:iv1–iv96.

    Article  PubMed  Google Scholar 

  4. 4.

    Lloyd RV, Osamura RY, Klöppel G, Rosai J (2017) WHO Classification of tumours of endocrine organs, 4th edn. IARC, Lyon

    Google Scholar 

  5. 5.

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

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Gittleman H, Ostrom QT, Farah PD et al (2014) Descriptive epidemiology of pituitary tumors in the United States, 2004–2009. J Neurosurg 121:527–535.

    Article  PubMed  Google Scholar 

  7. 7.

    Famini P, Maya MM, Melmed S (2011) Pituitary magnetic resonance imaging for sellar and parasellar masses: ten-year experience in 2598 patients. J Clin Endocrinol Metab 96:1633–1641.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Freda PU, Bruce JN, Khandji AG et al (2020) Presenting features in 269 patients with clinically nonfunctioning pituitary adenomas enrolled in a prospective study. J Endocr Soc 4:bvaa021.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Boffa DJ, Rosen JE, Mallin K et al (2017) Using the National Cancer Database for outcomes research: a review. JAMA Oncol 3:1722–1728.

    Article  Google Scholar 

  10. 10.

    Castellanos LE, Misra M, Smith TR et al (2021) The epidemiology and management patterns of pediatric pituitary tumors in the United States. Pituitary 24:412–419.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    McDowell BD, Wallace RB, Carnahan RM et al (2011) Demographic differences in incidence for pituitary adenoma. Pituitary 14:23–30.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Chen C, Hu Y, Lyu L et al (2021) Incidence, demographics, and survival of patients with primary pituitary tumors: a SEER database study in 2004–2016. Sci Rep 11:15155.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Agustsson TT, Baldvinsdottir T, Jonasson JG et al (2015) The epidemiology of pituitary adenomas in Iceland, 1955–2012: a nationwide population-based study. Eur J Endocrinol 173:655–664.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Song Y-J, Chen M-T, Lian W et al (2017) Surgical treatment for male prolactinoma. Med (Baltim) 96:e5833.

    Article  Google Scholar 

  15. 15.

    Chin SO (2020) Epidemiology of functioning pituitary adenomas. Endocrinol Metab 35:237–242.

    CAS  Article  Google Scholar 

  16. 16.

    Iglesias P, Arcano K, Triviño V et al (2017) Prevalence, clinical features, and natural history of incidental clinically non-functioning pituitary adenomas. Horm Metab Res 49:654–659.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Momin AA, Recinos MA, Cioffi G et al (2021) Descriptive epidemiology of craniopharyngiomas in the United States. Pituitary 24:517–522.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Ahmed A-K, Dawood HY, Arnaout OM et al (2018) Presentation, treatment, and long-term outcome of intrasellar chordoma: a pooled analysis of institutional, SEER (surveillance epidemiology and end results), and published data. World Neurosurg 109:e676–e683.

    Article  PubMed  Google Scholar 

  19. 19.

    Bohman L-E, Koch M, Bailey RL et al (2014) Skull base chordoma and chondrosarcoma: influence of clinical and demographic factors on prognosis: a SEER analysis. World Neurosurg 82:806–814.

    Article  PubMed  Google Scholar 

  20. 20.

    Das P, Soni P, Jones J et al (2020) Descriptive epidemiology of chordomas in the United States. J Neurooncol 148:173–178.

    Article  PubMed  Google Scholar 

  21. 21.

    Gupta S, Iorgulescu JB, Hoffman S et al (2020) The diagnosis and management of primary and iatrogenic soft tissue sarcomas of the sella. Pituitary 23:558–572.

    Article  PubMed  Google Scholar 

  22. 22.

    Maartens NF, Ellegala DB, Vance ML et al (2003) Intrasellar schwannomas: report of two cases. Neurosurgery 52:1200–1205; discussion 1205–1206

    PubMed  Google Scholar 

  23. 23.

    Cugati G, Singh M, Symss NP et al (2012) Primary intrasellar schwannoma. J Clin Neurosci Off J Neurosurg Soc Australas 19:1584–1585.

    Article  Google Scholar 

  24. 24.

    Honegger J, Koerbel A, Psaras T et al (2005) Primary intrasellar schwannoma: clinical, aetiopathological and surgical considerations. Br J Neurosurg 19:432–438.

    Article  PubMed  Google Scholar 

  25. 25.

    Kong X, Wu H, Ma W et al (2016) Schwannoma in sellar region mimics invasive pituitary macroadenoma: literature review with one case report. Med (Baltim) 95:e2931.

    Article  Google Scholar 

  26. 26.

    Mohammed S, Kovacs K, Munoz D, Cusimano MD (2010) A short illustrated review of sellar region schwannomas. Acta Neurochir (Wien) 152:885–891.

    Article  Google Scholar 

  27. 27.

    Zhang J, Xu S, Liu Q et al (2016) Intrasellar and suprasellar schwannoma misdiagnosed as pituitary macroadenoma: a case report and review of the literature. World Neurosurg 96:612.

    Article  PubMed  Google Scholar 

  28. 28.

    Giantini Larsen AM, Cote DJ, Zaidi HA et al (2018) Spindle cell oncocytoma of the pituitary gland. J Neurosurg 131:517–525.

    Article  PubMed  Google Scholar 

  29. 29.

    Kleinschmidt-DeMasters BK, Lopes MBS (2013) Update on hypophysitis and TTF-1 expressing sellar region masses. Brain Pathol Zurich Switz 23:495–514.

    Article  Google Scholar 

  30. 30.

    Lefevre E, Bouazza S, Bielle F, Boch A-L (2018) Management of pituicytomas: a multicenter series of eight cases. Pituitary 21:507–514.

    Article  PubMed  Google Scholar 

  31. 31.

    Viaene AN, Lee EB, Rosenbaum JN et al (2019) Histologic, immunohistochemical, and molecular features of pituicytomas and atypical pituicytomas. Acta Neuropathol Commun 7:69.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Cole TS, Potla S, Sarris CE et al (2019) Rare thyroid transcription factor 1-positive tumors of the sellar region: barrow neurological institute retrospective case series. World Neurosurg 129:e294–e302.

    Article  PubMed  Google Scholar 

  33. 33.

    Guerrero-Pérez F, Vidal N, Marengo AP et al (2019) Posterior pituitary tumours: the spectrum of a unique entity. A clinical and histological study of a large case series. Endocrine 63:36–43.

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Whipple SG, Savardekar AR, Rao S et al (2021) Primary tumors of the posterior pituitary gland: a systematic review of the literature in light of the new 2017 World Health Organization classification of pituitary tumors. World Neurosurg 145:148–158.

    Article  PubMed  Google Scholar 

  35. 35.

    Ahmed A-K, Dawood HY, Cote DJ et al (2019) Surgical resection of granular cell tumor of the sellar region: three indications. Pituitary 22:633–639.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Pernicone PJ, Scheithauer BW, Sebo TJ, et al (1997) Pituitary carcinoma: a clinicopathologic study of 15 cases. Cancer 79:804–812

    CAS  Article  Google Scholar 

  37. 37.

    Hansen TM, Batra S, Lim M et al (2014) Invasive adenoma and pituitary carcinoma: a SEER database analysis. Neurosurg Rev 37:279–285. discussion 285–286.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Carey RM, Kuan EC, Workman AD et al (2020) A population-level analysis of pituitary carcinoma from the National Cancer Database. J Neurol Surg Part B Skull Base 81:180–186.

    Article  Google Scholar 

  39. 39.

    Lenders NF, Inder WJ, McCormack AI (2021) Towards precision medicine for clinically non-functioning pituitary tumours. Clin Endocrinol (Oxf).

    Article  Google Scholar 

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JBI gratefully acknowledges funding support from the National Cancer Institute (K12CA090354) and Conquer Cancer Foundation. LEC acknowledges funding support from the NIH (T32DK007028). CG is an NCI F31 Diversity Individual Predoctoral Fellow.

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Correspondence to J. Bryan Iorgulescu.

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Castellanos, L.E., Gutierrez, C., Smith, T. et al. Epidemiology of common and uncommon adult pituitary tumors in the U.S. according to the 2017 World Health Organization classification. Pituitary (2021).

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  • Pituitary tumor
  • Pituitary adenoma
  • Craniopharyngioma
  • Epidemiology
  • Pituitary carcinoma
  • Tumor of the posterior pituitary