Pituitary Adenomas with Changing Phenotype: A Systematic Review
| Autor: | Noemi Vidal, Carles Villabona, Fernando Guerrero-Pérez, Agustina Pia Marengo |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Somatotropic cell Endocrinology Diabetes and Metabolism medicine.medical_treatment Disease Young Adult 03 medical and health sciences 0302 clinical medicine Endocrinology Microprolactinoma Acromegaly Internal Medicine medicine Null cell Humans Pituitary Neoplasms Aged business.industry General Medicine Middle Aged medicine.disease Surgery Radiation therapy 030220 oncology & carcinogenesis Pituitary carcinoma Disease Progression Female Corticotropic cell business 030217 neurology & neurosurgery |
| Zdroj: | Experimental and Clinical Endocrinology & Diabetes. 128:835-844 |
| ISSN: | 1439-3646 0947-7349 |
| DOI: | 10.1055/a-1120-8277 |
| Popis: | Purpose and Methods Phenotype transformation in pituitary adenomas (PA) is a little known and unexpected clinical phenomenon. We describe two illustrative cases and performed a systematic review of cases reported in literature. Results Case 1: A 24-year-old woman underwent surgery because of Cushing’s disease. A complete tumor resection and hypercortisolism resolution was achieved. Two years later, tumor recurred but clinical and hormonal hypercortisolism were absent. Case 2: A 77-year-old woman underwent surgery due to acromegaly. A complete tumor resection and GH excess remission was achieved. Four years later, tumor recurred but clinical and hormonal acromegaly was ruled out. Search of literature: From 20 patients (including our cases), 75% were female with median age 45 (19) years. Ten patients (50%) had initially functioning PA: 8 switched to NFPA (5 ACTH-secreting PA, 2 prolactinomas and 1 acromegaly) and 2 exchanged to acromegaly from TSH-secreting PA and microprolactinoma. One patient developed a pituitary carcinoma from ACTH-secreting PA. Ten patients (50%) initially had NFPA; 9 developed Cushing’s disease (4 silent corticotroph adenomas, 4 null cell PA and 1 managed conservatively). One patient with silent somatotroph PA changed to acromegaly. Treatments before transformation were surgery (80%), radiotherapy (40%), pharmacological (40%) and in 2 patients switching happened without any treatment. Median follow-up until transformation was 72 months (range 12–276). Conclusion PA can change from functioning to (NF) non-functioning (vice versa) and even exchange their hormonal expression. Clinicians should be aware and a careful lifelong follow-up is mandatory to detect it. |
| Databáze: | OpenAIRE |
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