Pituitary adenoma classification: Difference between revisions
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==Overview== | ==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 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== | ==Classification== | ||
*Historically, pituitary tumors were classified as [[basophilic]], [[acidophile|acidophilic]], or [[chromophobic]] based on the positivity of [[hematoxylin]] and [[eosin]] stain. | *Historically, pituitary tumors were classified as [[basophilic]], [[acidophile|acidophilic]], or [[chromophobic]] based on the positivity of [[hematoxylin]] and [[eosin]] stain. | ||
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|! style="background: #4479BA; color:#FFF;" |'''Pathology''' | |! style="background: #4479BA; color:#FFF;" |'''Pathology''' | ||
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| style="background: #F0F0F0;" align=center |''[[Corticotrophic]] ''adenomas || 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]] | ||
|- | |- | ||
| style="background: #F0F0F0;" align=center |[[Somatotrophic]] adenomas'' || Growth hormone ([[GH]]) || [[Acidophile (histology)|Acidophilic]] || [[Acromegaly]] (gigantism) | | style="background: #F0F0F0;" align=center |[[Somatotrophic]] adenomas'' ||[[Growth hormone]] ([[GH]]) ||[[Acidophile (histology)|Acidophilic]] || [[Acromegaly]] ([[gigantism]]) | ||
|- | |- | ||
| style="background: #F0F0F0;" align=center |[[Thyrotrophic]] ''adenomas (rare) ||Thyroid-stimulating hormone ([[TSH]]) || [[Anterior pituitary basophil|Basophilic]] || Occasionally [[hyperthyroidism]] | | style="background: #F0F0F0;" align=center |[[Thyrotrophic]] ''adenomas (rare) ||[[Thyroid-stimulating hormone]] ([[TSH]]) ||[[Anterior pituitary basophil|Basophilic]] || Occasionally [[hyperthyroidism]]/[[Asymptomatic]] | ||
|- | |- | ||
| style="background: #F0F0F0;" align=center |''[[Gonadotrophic]] ''adenomas || Luteinizing hormone ([[LH]]), follicle-stimulating hormone ([[FSH]]) and their subunits || [[Anterior pituitary basophil|Basophilic]] || | | style="background: #F0F0F0;" align=center |''[[Gonadotrophic]] ''adenomas ||[[Luteinizing hormone]] ([[LH]]), [[follicle-stimulating hormone]] ([[FSH]]) and their subunits ||[[Anterior pituitary basophil|Basophilic]] ||[[Asymptomatic]] | ||
|- | |- | ||
| style="background: #F0F0F0;" align=center |''[[Lactrotrophic]] adenomas'' or ''[[prolactinoma]]s'' (most common) || [[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]] | ||
|- | |- | ||
| style="background: #F0F0F0;" align=center |''[[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=== | ===Classification based on the size of the adenoma=== | ||
Pituitary adenoma may be classified into 4 grades based on radioanatomical:<ref name=National | 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 I''' involves microadenomas (<1 cm) without [[sella]] expansion | ||
*'''Stage II''' involves macroadenomas (≥1 cm) and may extend above the sella | *'''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 extension | *'''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 | *'''Stage IV''' involves macroadenomas that cause destruction of the [[Sella turcica|sella]] | ||
==References== | ==References== | ||
Latest revision as of 19:32, 2 October 2019
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Pituitary adenoma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Pituitary adenoma classification On the Web |
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American Roentgen Ray Society Images of Pituitary adenoma classification |
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Risk calculators and risk factors for Pituitary adenoma classification |
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