Endocrine Abstracts

JOINT2625

Introduction: Non-functional pituitary adenomas are benign neoplasms that arise from adenohypophyseal cells and are not associated with clinical signs of hormonal hypersecretion. They form a broad and heterogeneous group Plurihormonal adenomas can be classified into two groups: “PIT1-positive adenomas” (formerly known as subtype 3 silent pituitary adenomas); and plurihormonal adenomas with more than one transcription factor, known as ‘plurihormonal adenomas with unusual immunohistochemical combinations’. WE present the case of a rare plurihormonal combination of a non-functioning macrodenoma.

Observation: Patient aged 27 The onset of symptoms dates back to July 2023, with the onset of a drop in visual acuity, prompting the patient to consult an ophthalmologist for a visual field test, which revealed a bitemporal hemianopia, followed by a pituitary-hypothaloid MRI, which showed an invasive pituitary macroadenoma. adenoma, initially measuring 42*49*25mm, referred urgently for neurosurgery in view of the visual repercussions. Moreover, the patient reported no signs or symptoms related to tumour hypersecretion identified by a preoperative work-up, including IGF1, which returned normal at 184ng/ml for his age. HISTOCHIMIC study was in favour of a plurihormonal pituitary adenoma strongly expressing GH, weakly ACTH and LH, with KI67 estimated at 2% The evolution in 03 months post-op was marked by the persistence of a pituitary residue measuring 15*14*12mm on control MRI, completed by an endocrine work-up showing gonadal, thyroid and corticotropic anteropituitary insufficiency. and IGF levels normal for age. In addition, the patient did not report any tumour symptoms, such as headaches or reduced visual acuity.

Discussion: Patients with non-functional pituitary adenomas have less chance of remission than patients with functional pituitary adenomas. Adenomas can progress after surgical treatment, with regrowth rates of 15-66% in patients with non-functional adenomas treated with surgery alone, and 2-28% in those treated with surgery and radiotherapy. Long-term radiological monitoring after treatment of these adenomas is therefore recommended. No convincing prognostic factors for recurrence of these adenomas have yet been found. Clinical factors such as age, gender, tumor size and tumor invasion have limited predictive value for tumor progression. On the other hand, Ki-67 has been described as an independent cellular marker of tumor progression and recurrence.

Bibliography: Non-Functioning Pituitary Adenomas Juliana Beaudette Drummond, MD, PhD, Antônio Ribeiro-Oliveira, Jr., MD, PhD, and Beatriz Santana Soares, MD, PhD. Last Update: October 12, 2022.