Plurihormonal Adenomas

Abstract

Plurihormonal or mixed anterior pituitary adenomas are derived from a single (monomorphous) or mixed cell (polymorphous) lineage and are characterized by expression of two or more pituitary hormones. These adenomas comprise approximately 10–30% of resected adenomas and most commonly immunostain positively for growth hormone (GH) and prolactin (PRL). Expression of other anterior pituitary hormones, including adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH), may also occur. Since some pituitary tumors may be silent, clinical signs, symptoms, or elevated hormone levels can be absent. Management of plurihormonal adenomas is guided by clinical presentation, the degree and expression of pituitary hormones, and local mass effects.