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Double separate versus contiguous pituitary adenomas: MRI features and endocrinological follow up

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Abstract

Purpose

Double pituitary adenomas are defined as two adenomas within a gland. These have distinct light microscopic and immunohistochemical features and may be clearly-separate or contiguous. Most reports have focused on the various hormonal combinations in double tumors rather than on any potential increased risk for residual mass or endocrinopathy.

Methods

Departmental files were searched to identify all double adenomas from 1/1/2000 to 3/1/2016, with review of magnetic resonance imaging (MRI) to determine if the dual nature of the lesions could be discerned retrospectively after histologic diagnosis of double adenoma. All cases were immunostained for standard anterior pituitary hormones.

Results

Eight cases were identified: 2 follicle-stimulating hormone (FSH)/alpha subunit (ASU) + prolactinoma (PRL); 1 PRL + corticotroph (ACTH); 1 hormone-negative + PRL; 1 ACTH + ASU/growth hormone (GH)/PRL; 1 GH/PR + PRL; 1 FSH/ASU, + ACTH; 1 GH + luteinizing hormone (LH). One patient had clearly-separate lesions identified preoperatively and required two surgical procedures for gross total resection. A second patient had 2 lesions recognized at surgery and afterwards on retrospective neuroimaging. The remaining 6 patients had double adenomas discovered at the time of histologic examination that were not resolvable at surgery or on retrospective neuroimaging. Four patients, 2 with clearly-separate and 2 with contiguous double adenomas, had persistent MRI abnormalities, and one had continued endocrine abnormalities.

Conclusions

Double contiguous pituitary adenomas are difficult to anticipate preoperatively or to resolve intraoperatively. Although double contiguous adenomas are much more common than double separate lesions, both have a risk for subtotal resection and, thus, residual mass and/or endocrinopathy may ensue.

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Acknowledgments

The authors thank Ms. Lisa Litzenberger for photographic expertise and Mrs. Diane Hutchinson for manuscript preparation.

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Authors and Affiliations

  1. Department of Pathology, Anschutz Medical Campus, University of Colorado at Denver, 12605 E. 16th Avenue, Aurora, CO, 80045, USA

    Sammie Roberts & B. K. Kleinschmidt-DeMasters

  2. Department of Neuroradiology, Anschutz Medical Campus, University of Colorado at Denver, 12605 E. 16th Avenue, Aurora, CO, 80045, USA

    Manuel Thomas Borges

  3. Department of Neurosurgery, Anschutz Medical Campus, University of Colorado at Denver, 12605 E. 16th Avenue, Aurora, CO, 80045, USA

    Kevin O. Lillehei & B. K. Kleinschmidt-DeMasters

  4. Department of Neurology, Anschutz Medical Campus, University of Colorado at Denver, 12605 E. 16th Avenue, Aurora, CO, 80045, USA

    B. K. Kleinschmidt-DeMasters

Authors
  1. Sammie Roberts
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  2. Manuel Thomas Borges
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  3. Kevin O. Lillehei
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  4. B. K. Kleinschmidt-DeMasters
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Corresponding author

Correspondence to B. K. Kleinschmidt-DeMasters.

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Ethical approval

The research presented in this paper was submitted to the Colorado Multiple Institutional Review Board (COMIRB) and was approved for exemption from further review. In addition, a certificate of HIPAA compliance was granted by the COMIRB based on the determination that this research meets criteria for a full waiver of HIPAA authorization.

Conflict of interest

The authors have no conflicts of interest to disclose.

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Roberts, S., Borges, M.T., Lillehei, K.O. et al. Double separate versus contiguous pituitary adenomas: MRI features and endocrinological follow up. Pituitary 19, 472–481 (2016). https://doi.org/10.1007/s11102-016-0727-0

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  • DOI: https://doi.org/10.1007/s11102-016-0727-0

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