Pituitary adenoma classification: Difference between revisions

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Latest revision as of 19:32, 2 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]

Overview

Pituitary adenoma may be classified according to the size of the adenoma and type of hormone secretion, subtypes include corticotrophic, somatotrophic, thyrotrophic, gonadotrophic, and lactrotrophic adenomas.

Classification

Historically, pituitary tumors were classified as basophilic, acidophilic, or chromophobic based on the positivity of hematoxylin and eosin stain.
Newer classification is based on either the size or the functional status of the adenoma (secretory vs. non-secretory).

Classification based on hormone secretion and immunohistochemical staining

Type of adenoma	Secretion	Staining	Pathology
Corticotrophic adenomas	Adrenocorticotropic hormone (ACTH) and pro-opiomelanocortin (POMC)	Basophilic	Cushing's disease
Somatotrophic adenomas	Growth hormone (GH)	Acidophilic	Acromegaly (gigantism)
Thyrotrophic adenomas (rare)	Thyroid-stimulating hormone (TSH)	Basophilic	Occasionally hyperthyroidism/Asymptomatic
Gonadotrophic adenomas	Luteinizing hormone (LH), follicle-stimulating hormone (FSH) and their subunits	Basophilic	Asymptomatic
Lactrotrophic adenomas or prolactinomas (most common)	Prolactin	Acidophilic	Galactorrhea, hypogonadism, amenorrhea, infertility, and impotence
Null cell adenomas	Do not secrete hormones	May stain positive for synaptophysin

Classification based on the size of the adenoma

Pituitary adenoma may be classified into 4 grades based on radioanatomical:

Stage I involves microadenomas (<1 cm) without sella expansion
Stage II involves macroadenomas (≥1 cm) and may extend above the sella
Stage III involves macroadenomas with enlargement and invasion of the floor or suprasellar extension
Stage IV involves macroadenomas that cause destruction of the sella

References

Template:WikiDoc Sources

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 __NOTOC__
 {{Pituitary adenoma}}
-{{CMG}}
+{{CMG}} {{AE}} {{AAM}}
 ==Overview==
+Pituitary adenoma may be classified according to the size of the adenoma and  type of [[hormone]] secretion, subtypes include [[corticotrophic]], [[somatotrophic]], [[thyrotrophic]], [[gonadotrophic]], and [[lactrotrophic]] adenomas.
-'''Pituitary adenomas''' are [[tumor]]s that occur in the [[pituitary gland]], and account for about 10% of intracranial [[neoplasia|neoplasms]]. They often remain undiagnosed, and small pituitary tumors are found in 6 to 24 percent of adults at autopsy.
-Pituitary adenomas arise within the anterior lobe (adenohypophysis) of the gland . Tumors less than 1 cm are called micro adenomas. Clinical symptoms depend on whether the tumor is secreting or nonsecreting. Nonsecreting adenomas grow and compress adjacent structures, most commonly causing a bitemporal hemianopsia due to chiasmatic compression. Lateral extension into the cavernous sinuses can result in cranial nerve palsies.
 ==Classification==
-Pituitary tumors were, historically, classed as [[basophilic]], [[Acidophile|acidophilic]], or [[chromophobic]] on the basis of whether or not they took up the stains [[hematoxylin]] and [[eosin]]. This classification has fallen into disuse, in favor of a classification based on what type of [[hormone]] is secreted by the tumor (though tumors which do not secrete any active hormone ("non-functioning tumors") are still sometimes called "chromophobic").
+*Historically, pituitary tumors were classified as [[basophilic]], [[acidophile|acidophilic]], or [[chromophobic]] based on the positivity of [[hematoxylin]] and [[eosin]] stain.
-At present, classification of pituitary tumors is based on plasma hormone levels or [[immunohistochemical staining]]:
+*Newer classification is based on either the size or the functional status of the adenoma (secretory vs. non-secretory).
+===Classification based on hormone secretion and immunohistochemical staining===
 {| class="wikitable"
-| '''Type of adenoma''' || '''Secretion''' || '''Staining''' || '''Pathology'''
+|! style="background: #4479BA; color:#FFF;" | '''Type of '''adenoma
+|! style="background: #4479BA; color:#FFF;" |'''Secretion'''
+|! style="background: #4479BA; color:#FFF;" |'''Staining'''
+|! style="background: #4479BA; color:#FFF;" |'''Pathology'''
   |-
- | ''[[Corticotrophic]] adenomas'' ||  secrete adrenocorticotropic hormone ([[ACTH]]) and pro-opiomelanocortin ([[POMC]]) || [[Anterior pituitary basophil|basophilic]] || [[Cushing's disease]]
+| style="background: #F0F0F0;" align=center |''[[Corticotrophic]] ''adenomas ||[[Adrenocorticotropic hormone]] ([[ACTH]]) and [[pro-opiomelanocortin]] ([[POMC]]) ||[[Anterior pituitary basophil|Basophilic]] || [[Cushing's disease]]
   |-
- | ''[[Somatotrophic]] adenomas'' ||  secrete growth hormone ([[GH]]) || [[Acidophile (histology)|acidophilic]] || [[acromegaly]] (gigantism)
+| style="background: #F0F0F0;" align=center |[[Somatotrophic]] adenomas'' ||[[Growth hormone]] ([[GH]]) ||[[Acidophile (histology)|Acidophilic]] || [[Acromegaly]] ([[gigantism]])
   |-
- | ''[[Thyrotrophic]] adenomas'' (rare) ||  secrete thyroid-stimulating hormone ([[TSH]]) || [[Anterior pituitary basophil|basophilic]] || occasionally [[hyperthyroidism]]{{ref|thyrotrophic}}, usually doesn't cause symptoms
+| style="background: #F0F0F0;" align=center |[[Thyrotrophic]] ''adenomas (rare) ||[[Thyroid-stimulating hormone]] ([[TSH]]) ||[[Anterior pituitary basophil|Basophilic]] || Occasionally [[hyperthyroidism]]/[[Asymptomatic]]
   |-
- | ''[[Gonadotrophic]] adenomas'' ||  secrete luteinizing hormone ([[LH]]), follicle-stimulating hormone ([[FSH]]) and their subunits || [[Anterior pituitary basophil|basophilic]] || usually doesn't cause symptoms
+| style="background: #F0F0F0;" align=center |''[[Gonadotrophic]] ''adenomas ||[[Luteinizing hormone]] ([[LH]]), [[follicle-stimulating hormone]] ([[FSH]]) and their subunits ||[[Anterior pituitary basophil|Basophilic]] ||[[Asymptomatic]]
   |-
- | ''[[Lactrotrophic]] adenomas'' or ''[[prolactinoma]]s'' (most common) ||  secrete [[prolactin]]  || [[Acidophile (histology)|acidophilic]] || [[galactorrhea]], [[hypogonadism]], [[amenorrhea]], [[infertility]], and [[impotence]]
+| style="background: #F0F0F0;" align=center |''[[Lactrotrophic]] adenomas'' or ''[[prolactinoma]]s'' (most common) || [[Prolactin]]  || [[Acidophile (histology)|Acidophilic]] || [[Galactorrhea]], [[hypogonadism]], [[amenorrhea]], [[infertility]], and [[impotence]]
   |-
- |  ''[[Null cell]] adenomas'' || do not secrete hormones || may stain positive for [[synaptophysin]] ||
+| style="background: #F0F0F0;" align=center |''[[Null cell]] adenomas'' || Do not secrete [[hormones]]|| May stain positive for [[synaptophysin]] ||
 |}
+===Classification based on the size of the adenoma===
+Pituitary adenoma may be classified into 4 grades based on radioanatomical:<ref name="National" cancer="" institute=""> Pituitary adenoma (2015). http://www.cancer.gov/types/pituitary/hp/pituitary-treatment-pdq#section/_96. Accessed on 9/28/2015.</ref>
+*'''Stage I''' involves microadenomas (<1 cm) without [[sella]] expansion
+*'''Stage II''' involves macroadenomas (≥1 cm) and may extend above the [[Sella turcica|sella]]
+*'''Stage III''' involves macroadenomas with enlargement and invasion of the floor or [[Suprasellar tumors|suprasellar]] extension
+*'''Stage IV''' involves macroadenomas that cause destruction of the [[Sella turcica|sella]]
 ==References==
 {{Reflist|2}}
-[[cs:Adenom hypofýzy]]
-[[nl:Hypofysetumor]]
-[[sk:Adenóm hypofýzy]]
-[[sv:Hypofystumör]]
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