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High-risk pituitary adenomas and strategies for predicting response to treatment

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Abstract

High-risk pituitary adenomas are aggressive. They show clinical and imaging features similar to those of carcinomas, including infiltration of the surrounding brain structures, but lack cerebrospinal or systemic metastases. In addition, they display distinct behavior, including tendency for fast growth and frequent recurrences, which are difficult to control. The term “high-risk” adenoma was first introduced in the 4th edition of the World Health Organization Classification of Endocrine Tumors in 2017. Five defined adenoma types belong to this category, including sparsely granulated somatotroph, lactotroph in men, Crooke cell, silent corticotroph, and plurihormonal PIT-1 positive adenomas. The morphological and immunohistochemical characteristics of high-risk adenomas are herein described in detail. In addition, the clinical features and the treatment options are presented. This review focuses on predictive markers assessed by immunohistochemistry, which help clinicians to design the appropriate treatment strategies for high-risk adenomas. Somatostatin receptor status predicts effectiveness of postsurgical treatment with somatostatin analogs, and MGMT expression predicts response to treatment with temozolomide. This comprehensive review presents the clinical and pathological features of high-risk pituitary adenomas, underlines the contribution of immunohistochemistry, and emphasizes the leading role of pathology in the design of optimal clinical management.

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Funding

This work was financially supported in part by the Pituitary Research Society.

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Authors and Affiliations

  1. Division of Endocrinology, First Propaedeutic Department of Internal Medicine, Laikon Hospital, National and Kapodistrian University of Athens, Athens, Greece

    George Kontogeorgos

  2. Department of Pathology and Pituitary Tumor Reference Center, G. Gennimatas General Hospital of Athens, Athens, Greece

    George Kontogeorgos

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

    Eleni Thodou

  4. Department of Pathology, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan

    Robert Y. Osamura

  5. Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Ricardo V. Lloyd

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  1. George Kontogeorgos
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Correspondence to George Kontogeorgos.

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Kontogeorgos, G., Thodou, E., Osamura, R.Y. et al. High-risk pituitary adenomas and strategies for predicting response to treatment. Hormones 21, 1–14 (2022). https://doi.org/10.1007/s42000-021-00333-y

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