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Note |
The relative incidence of the different pituitary adenomas subtypes is diagrammed in Fig.1 |
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Various subtypes have been recognized on the basis of clinical presentation, as well as immunocytological and ultrastructural characteristics. About one-third of pituitary adenomas are not associated with clinical hypersecretory syndromes, but with symptoms of an intracranial mass such as headaches, hypopituitarism, or visual field disturbances, and are classified as nonfunctioning pituitary adenomas (NFPAs). Clinically non-functioning adenomas (NFPA) are actually a diverse group of tumors that include LH-, FSH- secreting adenomas, null cell adenoma and oncocytoma. The clinical features of all other pituitary adenomas are linked to the hypersecreted hormone(s) which mark the specific cell origin, allowing the tumors to be classified as: Prolactinomas or PRL-secreting PA, the most common of all functional pituitary adenomas. The patients usually present with amenorrhea, infertility, and galactorrhea (females), impotence or infertility (males). Tumors expressing both PRL and GH are thought to originate from a common mammosomatotroph precursor cell. Somatotropinomas or GH-secreting PA, which cause acromegaly in adults, with bony acral changes in soft tissues and bone, and increased risk of hypertension, cardiac disease, and diabetes. Corticotropinomas or ACTH-secreting PA, leading to Cushing disease and adrenal steroid overstimulation. Features of hypercortisolism include truncal obesity, striae, muscle wasting, hirsutism, cardiovascular complications, osteoporosis, and psychiatric disturbances. Pure gonadotropinomas secreting intact FSH or LH are rarely encountered and may cause sexual dysfunction and hypogonadism. Thyrotropinomas cause a mild increase in thyroxine levels with inappropriate TSH levels. |
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