Skip to main content

Advertisement

SpringerLink
Log in

Treatment of Invasive Silent Somatotroph Pituitary Adenoma with Temozolomide. Report of a Case and Review of the Literature

  • Published:
Endocrine Pathology Aims and scope Submit manuscript

Abstract

Improved imaging techniques have contributed to increased diagnosis of pituitary tumors. These tumor types can be microadenomas or macroadenomas and can either be functional or non-functional. Atypical or aggressive pituitary adenomas are tumors that rapidly increase in size and may invade into the suprasellar or parasellar regions. They are characterized by a Ki-67 nuclear labeling index greater than 10 %. Management of these tumors is difficult, and many recur after surgery. Temozolomide, a second generation alkylating agent, has been showing promising results in the treatment of these tumors. The patient was a 39-year-old male diagnosed with an invasive silent somatotroph pituitary macroadenoma treated with temozolomide after surgery. We present the case along with the review of the literature of the therapeutic effects of temozolomide in somatotroph macroadenomas.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ezzat S, Asa SL, Couldwell WT, Barr WE, Vance ML, McCutcheon IE (2004) The prevalence of pituitary adenomas: a systematic review. Cancer 101: 613-619.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  3. Di Ieva A, Rotondo F, Syro LV, Cusimano MD, Kovacs K (2014) Aggressive pituitary adenomas-diagnosis and emerging treatments. Nat Rev Endocrinol10:423-435.

    Article  PubMed  Google Scholar 

  4. Ortiz LD, Syro LV, Scheithauer BW, Rotondo F, Uribe H, Fadul CE, et al (2012) Temozolomide in aggressive pituitary adenomas and carcinomas. Clinics 67 (S1):119-123.

    Article  PubMed Central  PubMed  Google Scholar 

  5. McCormack AI, McDonald KL, Gill AJ, Clark SJ, Burt MG, Campbell KA, et al (2009) Low O6-methylguanine-DNA methyltransferase (MGMT) expression and response to temozolomide in aggressive pituitary tumours. ClinEndocrinol 71: 226-233.

    CAS  Google Scholar 

  6. Morin E, Berthelet F, Weisnagel J, Bidlingmaier M, Serri O (2012) Failure of temozolomide and conventional doses of pegvisomant to attain biochemical control in a severe case of acromegaly. Pituitary 15: 97-100.

    Article  CAS  PubMed  Google Scholar 

  7. Batisse M, Raverot G, Maqdasy S, Maqdasy S, Durando X, Sturm N, Montoriol PF, et al (2013) Aggressive silent GH pituitary tumor resistant to multiple treatments, including temozolomide. Cancer Invest 31: 190-196.

    Article  CAS  PubMed  Google Scholar 

  8. Raverot G, Castinetti F, Jouanneau E, Morange I, Figarella-Branger D, Dufour H, et al (2012) Pituitary carcinomas and aggressive pituitary tumours: merits and pitfalls of temozolomide treatment. ClinEndocrinol 76: 769-775.

    CAS  Google Scholar 

  9. Mete O, Asa SL (2012) Clinicopathological correlations in pituitary adenomas. Brain Pathol 22: 443-453.

    Article  PubMed  Google Scholar 

  10. Zada G, Woodmansee WW, Ramkissoon S, Amadio J, Nose V, Laws ER, Jr (2011) Atypical pituitary adenomas: incidence, clinical characteristics, and implications. J Neurosurg 114: 336-344.

    Article  PubMed  Google Scholar 

  11. Asa SL, Ezzat S (2014) Genomic approaches to problems in pituitary neoplasms. EndocrPathol25:209-213.

    CAS  Google Scholar 

  12. DeLellis R, Lloyd RV, Heitz P, Eng C (eds.): World Health Organization classification of tumours: tumours of endocrine organs. Lyon: IARC Press, 2004.

    Google Scholar 

  13. Raverot G, Jouanneau E, Trouillas J (2014) Management of endocrine disease: clinicopathological classification and molecular markers of pituitary tumours for personalized therapeutic strategies. Eur J Endocrinol 170: R121-132.

    Article  CAS  PubMed  Google Scholar 

  14. McCormack AI, Wass JA, Grossman AB (2011) Aggressive pituitary tumours: the role of temozolomide and the assessment of MGMT status. Eur J ClinInvest 41: 1133-1148.

    Article  CAS  Google Scholar 

  15. Saeger W, Ludecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ, Petersenn S (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 

  16. Kulke MH, Styart K, Enzinger PC, Ryan DP, Clark JW, Muzikansky A, et al (2006) Phase II study of temozolomide and thalidomide in patients with metastatic neuroendocrine tumors. J ClinOncol24:401-406.

    Article  CAS  Google Scholar 

  17. Agarwala SS, Kikwood JM (2000) Temozolomide, a novel alkylating agent with activity in the central nervous system, may improve the treatment of advanced metastatic melanoma. Oncologist 5:144-151.

    Article  CAS  PubMed  Google Scholar 

  18. Syro LV, Ortiz LD, Scheithauer BW, Lloyd RV, Lau Q, Gonzalez R, et al (2011) Treatment of pituitary neoplasms with temozolomide: a review. Cancer 117: 454-462.

    Article  CAS  PubMed  Google Scholar 

  19. Syro LV, Uribe H, Penagos LC, Ortiz LD, Fadul CE, Horvath E, Kovacs K (2006) Antitumor effects of temozolomide in a man with a large, invasive prolactin-producing pituitary neoplasm. ClinEndocrinol 65:552-553.

    Google Scholar 

  20. Hagen C, Schroeder HD, Hansen S, Andersen M (2009) Temozolomide treatment of a pituitary carcinoma and two pituitary macroadenomas resistant to conventional therapy. Eur J Endocrinol 161: 631-637.

    Article  CAS  PubMed  Google Scholar 

  21. Mohammed S, Kovacs K, Mason W, Smyth H, Cusimano MD (2009) Use of temozolomide in aggressive pituitary tumors: case report. Neurosurgery 64: E773-774; discussion E774.

    Article  PubMed  Google Scholar 

  22. Raverot G, Sturm N, de Fraipont F, Muller M, Salenave S, Caron P, et al (2010) Temozolomide treatment in aggressive pituitary tumors and pituitary carcinomas: a French multicenter experience. J ClinEndocrinolMetab 95: 4592-4599.

    Article  CAS  Google Scholar 

  23. Kovacs K, Scheithauer BW, Lombardero M, McLendon RE, Syro LV, Uribe H, et al (2008) MGMT immunoexpression predicts responsiveness of pituitary tumors to temozolomide therapy. ActaNeuropathol 115: 261-262

  24. Losa M, Mazza E, Terreni MR, McCormack A, Gill AJ, Motta M, et al (2010) Salvage therapy with temozolomide in patients with aggressive or metastatic pituitary adenomas: experience in six cases. Eur J Endocrinol 163: 843-851.

    Article  CAS  PubMed  Google Scholar 

  25. Bush ZM, Longtine JA, Cunningham T, Schiff D, Jane JA Jr, Vance ML, et al (2010) Temozolomide treatment for aggressive pituitary tumors: correlation of clinical outcome with O(6)-methylguaninemethyltransferase (MGMT) promoter methylation and expression. J ClinEndocrinolMetab 95: E280-290.

    Article  Google Scholar 

  26. Wade AN, Baccon J, Grady MS, Judy KD, O'Rourke DM, Snyder PJ (2011) Clinically silent somatotroph adenomas are common. Eur J Endocrinol 165: 39-44.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Daems T, Verhelst J, Michotte A, Abrams P, De Ridder D, Abs R (2009) Modification of hormonal secretion in clinically silent pituitary adenomas. Pituitary 12: 80-86.

    Article  CAS  PubMed  Google Scholar 

  28. Zuhur SS, Tanik C, Karaman O, Velet S, Cil E, Ozturk FY, et al (2011) MGMT immunoexpression in growth hormone-secreting pituitary adenomas and its correlation with Ki-67 labeling index and cytokeratin distribution pattern. Endocrine 40: 222-227.

    Article  CAS  PubMed  Google Scholar 

  29. Syro LV, Scheithauer BW, Ortiz LD, Fadul CE, Horvath E, Rotondo F, et al (2009) Effect of temozolomide in a patient with recurring oncocytic gonadotrophic pituitary adenoma. Hormones 8: 303-306.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Authors are grateful to the Jarislowsky and Lloyd Carr-Harris foundations for their support.

Conflict of Interest

Authors have no conflicts of interest to declare.

Compliance with Ethical Standards

This work has been conducted with the consent of the patient and in accordance to the St. Michael’s Hospital Ethics Committee where the work was undertaken. All work also conforms to the provisions of the Declaration of Helsinki.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

    Ali A Ghazi, Hussein Fathalla, Antonio Di Ieva & Michael D. Cusimano

  2. Department of Laboratory Medicine, Division of Pathology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

    Fabio Rotondo & Kalman Kovacs

  3. Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran

    Alireza Amirbaigloo

  4. Department of Neurosurgery, Hospital Pablo Tobon Uribe and Clinica Medellin, Medellin, Colombia

    Luis V Syro

Authors
  1. Ali A Ghazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabio Rotondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kalman Kovacs
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alireza Amirbaigloo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luis V Syro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hussein Fathalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antonio Di Ieva
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael D. Cusimano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabio Rotondo.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghazi, A.A., Rotondo, F., Kovacs, K. et al. Treatment of Invasive Silent Somatotroph Pituitary Adenoma with Temozolomide. Report of a Case and Review of the Literature. Endocr Pathol 26, 135–139 (2015). https://doi.org/10.1007/s12022-015-9361-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12022-015-9361-z

Keywords

Search

Navigation