[en] All endocrine glands are susceptible to neoplastic growth, yet the health consequences of these neoplasms differ between endocrine tissues. Pituitary neoplasms are highly prevalent and overwhelmingly benign, exhibiting a spectrum of diverse behaviors and impact on health. To understand the clinical biology of these common yet often innocuous neoplasms, we review pituitary physiology, and adenoma epidemiology, pathophysiology, behavior, and clinical consequences. The anterior pituitary develops in response to a range of complex brain signals integrating with intrinsic ectodermal cell transcriptional events that together determine gland growth, cell type differentiation, and hormonal production, in turn maintaining optimal endocrine health. Pituitary adenomas occur in ten percent of the population; however, the overwhelming majority remain harmless during life. Triggered by somatic or germline mutations, disease-causing adenomas manifest pathogenic mechanisms that disrupt intra-pituitary signaling to promote benign cell proliferation associated with chromosomal instability. Cellular senescence acts as a mechanistic buffer protecting against malignant transformation, an extremely rare event. It is estimated that fewer than one thousandth of all pituitary adenomas cause clinically significant disease. Adenomas variably and adversely affect morbidity and mortality depending on cell type, hormone secretory activity, and growth behavior. For most clinically apparent adenomas, multimodal therapy controlling hormone secretion and adenoma growth lead to improved quality of life and normalized mortality. The clinical biology of pituitary adenomas and particularly their benign nature stands in marked contrast to other tumors of the endocrine system such as thyroid and neuroendocrine tumors.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Melmed, Shlomo ; Cedars-Sinai Medical Center, Los Angeles, California, USA
Kaiser, Ursula B; Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
Lopes, M Beatriz ; University of Virginia School of Medicine, Charlottesville, Virginia, USA
Bertherat, Jerome; Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
Syro, Luis V; Hospital Pablo Tobon Uribe and Clinica Medellin - Grupo Quirónsalud, Medellin, Colombia
Raverot, Gerald ; Hospices Civils de Lyon and Lyon 1 University, Lyon, France
Reincke, Martin ; University Hospital of LMU, Ludwig-Maximilians-Universität, Munich, Germany
Johannsson, Gudmundur ; Sahlgrenska University Hospital & Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Beckers, Albert ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'endocrinologie clinique
Fleseriu, Maria; Oregon Health & Science University, Portland, Oregon, USA
Giustina, Andrea ; San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy
Wass, John A H; University of Oxford, Oxford, United Kingdom
Ho, Ken K Y; The Garvan Institute of Medical Research and St. Vincents Hospital, Sydney, Australia
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