Clinical Evaluation on Non-Functional Invasive Hypophysis Adenomas



There are ongoing studies to predetermine non-functional invasive pituitary adenomas which may show aggressive behavior. Our aim is to discuss whether there is a relationship between the immunohistochemical presence of GH, FSH, LH, PRL, ACTH, TSH and their aggressive clinical course in non-functional pituitary adenomas.

Materials and Methods

In this study, we evaluated retrospectively the files of the patients who were diagnosed with thesellar or parasellar tumor in our endocrinology clinic between the years of 2004-2014.The patients were divided into two groups as non-invasive pituitary adenomas and non-functional invasive pituitary adenomas. The immunohistochemical staining characteristics were compared between the two groups.


In this study, we scanned the data of 70 patients who were followed for non-functional sellar or parasellar mass. 47.1% of the patients were female and 52.9% of the patients were male.39 patients had a non-functional pituitary adenoma.The rate of non-functional invasive adenoma was found to be 20.5%. There was a significant relationship between the immunohistochemical positivity of GH, FSH, LH andaggressive behavior of non-functional invasive adenomas. There was no a significant relationship between the immunohistochemicalpositivityof PRL, ACTH, TSH and aggressive behavior of non-functional invasive adenomas.


We found silent GH and gonadotropin adenomas as non-functional aggressive pituitary adenoma. More aggressive treatment and close clinical monitoring should be performed because atypical pituitary adenomas are characterized by invasive growth and aggressive clinical course.

1- Asa SL. Practical Pituitary Pathology. What Does the Pathologist Need to Know? Arch Pathol Lab Med 2008;132:1231-40.
2- Buchfelder M. Management of aggressive pituitary adenomas: current treatment strategies. Pituitary 2009; 12; 256–260.
3- DeLellis R, Lloyd RV, Heitz P, Eng C (eds): World Health Organization Classification of Tumours: Tumours of Endocrine Organs. Lyon: IARC Press 2004; 10-35.
4- Davis JR, Farrell WE, Clayton RN: Pituitary tumours. Reproduction 2001; 121(3): 363-371.
5- Botelho CH, Magalhaes AV, Mello PA, Schmitt FC, Casulari LA. Expression of p53, Ki-67 and c-erb B2 in growth hormoneand/or prolactin-secreting pituitary adenomas. Arq Neuropsiquiatr 2006; 64(1): 60-66.
6- Zada G, Woodmansee WW, Ramkissoon S, et al. Atypical pituitary adenomas: incidence, clinical characteristics and implications. Journal of Neurosurgery 2011; 114, 336–344.
7- Tortosa F, Webb SM. Atypical pituitary adenomas: 10 years of experience in a reference centre in Portugal. Neurologia 2015; 0213-4853.
8- Saeger W, Lüdecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ, Petersenn S. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol 2007; 156:203–216, 2007
9- Gejman R, Swearingen B, Hedley-Whyte ET. Role of Ki-67 proliferation index and p53 expression in predicting progression of pituitary adenomas. Hum Pathol 2008; 39: 758-766.
10- Gomez-Hernandez K, Ezzat S, Asa SL, Mete Ö. Clinical Implications of Accurate Subtyping of Pituitary Adenomas: Perspectives from the Treating Physician. Turk Patoloji Derg 2015; 31 :4-17.
11- Pereira-Lima JF, Marroni CP, Pizarro CB, Barbosa-Coutinho LM, Ferreira NP, Oliveira MC.Immunohistochemical detection of estrogen receptor alpha in pituitary adenomas and its correlation with cellular replication. Neuroendocrinology2004; 79(3):119-24.
12- Zhou W, Song Y, Xu H, Zhou K, Zhang W, Chen J, et al. In nonfunctional pituitary adenomas, estrogen receptors and slug contribute to development of invasiveness. J Clin Endocrinol Metab 2011; 96(8): E1237-45.
13- Manoranjan B, Salehi F, Scheithauer BW, Rotondo F, Kovacs K, Cusimano MD. Estrogen receptors alpha and beta immunohistochemical expression: clinicopathological correlations in pituitary adenomas. Anticancer Res 2010; 30(7): 2897-90