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  • 1
    Online Resource
    Online Resource
    The evolution in pituitary tumour classification: a clinical perspective
    Bioscientifica ; 2023
    In:  Endocrine Oncology Vol. 3, No. 1 ( 2023-01-01)
    Details
    In: Endocrine Oncology, Bioscientifica, Vol. 3, No. 1 ( 2023-01-01)
    Abstract: Pituitary tumours comprise a pathologically and clinically diverse group of neoplasms. Classification frameworks have changed dramatically in the past two decades, reflecting improving understanding of tumour biology. This narrative review examines the evolution of pituitary tumour classification, from a clinical perspective. Results In 2004, pituitary tumours were classified as ‘typical’ or ‘atypical’, based on the presence of markers of proliferation, Ki67, mitotic count and p53. In 2017, the new WHO marked a major paradigm shift, with a new focus on lineage-based classification, determined by transcription factor and hormonal immunohistochemistry. The terms ‘typical’ and ‘atypical’ were omitted, though the importance of proliferative markers Ki67 and mitotic count was acknowledged. The recent WHO 2022 classification incorporates further refinements, specifically recognising some less common types that may represent less well-differentiated tumours. Whilst ‘high risk’ tumour types have been identified, further work is still required to improve prognostication. Conclusions Recent WHO classifications have marked significant progress in the diagnostic evaluation of pituitary tumours, though shortcomings and challenges remain for both clinicians and pathologists in managing these tumours.
    Type of Medium: Online Resource
    ISSN: 2634-4793
    URL: Article
    DOI: 10.1530/EO-22-0079
    Language: Unknown
    Publisher: Bioscientifica
    Publication Date: 2023
    detail.hit.zdb_id: 3143825-8
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  • 2
    Online Resource
    Online Resource
    Transcription factor immunohistochemistry in the diagnosis of pituitary tumours
    Oxford University Press (OUP) ; 2021
    In:  European Journal of Endocrinology Vol. 184, No. 6 ( 2021-06-01), p. 891-901
    Details
    In: European Journal of Endocrinology, Oxford University Press (OUP), Vol. 184, No. 6 ( 2021-06-01), p. 891-901
    Abstract: The clinical utility and prognostic value of WHO 2017 lineage-based classification of pituitary tumours have not been assessed. This study aimed to (1) determine the clinical utility of transcription factor analysis for classification of pituitary tumours and (2) determine the prognostic value of improved lineage-based classification of pituitary tumours. Methods This was a retrospective evaluation of patients who underwent surgical resection of pituitary tumours at St Vincent’s Public and Private Hospitals, Sydney, Australia between 1990 and 2016. Included patients were at least 18 years of age and had complete histopathological data, forming the 'histological cohort'. Patients with at least 12 months of post-surgical follow-up were included in the subgroup 'clinical cohort'. The diagnostic efficacy of transcription factor immunohistochemistry in conjunction with hormone immunohistochemistry was compared with hormone immunohistochemistry alone. The prognostic value of identifying 'higher-risk' histological subtypes was assessed. Results There were 171 patient tumour samples analyzed in the histological cohort. Of these, there were 95 patients forming the clinical cohort. Subtype diagnosis was changed in 20/171 (12%) of tumours. Within the clinical cohort, there were 21/95 (22%) patients identified with higher-risk histological subtype tumours. These were associated with tumour invasiveness ( P  = 0.050), early recurrence (12–24 months, P  = 0.013), shorter median time to recurrence (49 (IQR: 22.5–73.0) vs 15 (IQR: 12.0–25.0) months, P  = 0.005) and reduced recurrence-free survival ( P  = 0.031). Conclusions Application of transcription factor analysis, in addition to hormone immunohistochemistry, allows for refined pituitary tumour classification and may facilitate an improved approach to prognostication.
    Type of Medium: Online Resource
    ISSN: 0804-4643 , 1479-683X
    URL: Article
    DOI: 10.1530/EJE-20-1273
    RVK:
    WA 15000
    Language: Unknown
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 1485160-X
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  • 3
    Online Resource
    Online Resource
    MANAGEMENT OF ENDOCRINE DISEASE: Does gender matter in the management of acromegaly?
    Oxford University Press (OUP) ; 2020
    In:  European Journal of Endocrinology Vol. 182, No. 5 ( 2020-05), p. R67-R82
    Details
    In: European Journal of Endocrinology, Oxford University Press (OUP), Vol. 182, No. 5 ( 2020-05), p. R67-R82
    Abstract: Gonadal steroids modulate the effects of GH, with oestrogens attenuating and androgens augmenting GH action. Whether these divergent effects influence the clinical manifestation, management and prognosis of acromegaly have not been carefully reviewed. This review examines whether there is a gender difference in epidemiology, presentation, quality of life (QoL), morbidity, treatments and mortality of acromegaly. Acromegaly is more common in women who present at an older age with longer diagnostic delay. At presentation, women have a higher GH relative to IGF-1 level than men. QoL is more adversely affected in women both before and after treatment. Prevalence of hypertension and diabetes are greater in women than in men with acromegaly. Treatment outcomes with SSAs are comparable between sexes, but women may require a higher dose of pegvisomant for equivalent response. Mortality in untreated acromegaly is more profoundly affected in women; however, improved treatments in recent decades have resulted in normalisation of standard mortality ratios in both sexes. We conclude that gender does matter in the management of acromegaly, with women presenting later in life, with greater diagnostic delay, higher prevalence of comorbidities and experiencing worse QoL.
    Type of Medium: Online Resource
    ISSN: 0804-4643 , 1479-683X
    URL: Article
    DOI: 10.1530/EJE-19-1023
    RVK:
    WA 15000
    Language: Unknown
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 1485160-X
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  • 4
    Online Resource
    Online Resource
    Predictors of pituitary tumour behaviour: an analysis from long-term follow-up in 2 tertiary centres
    Oxford University Press (OUP) ; 2023
    In:  European Journal of Endocrinology Vol. 189, No. 1 ( 2023-07-20), p. 106-114
    Details
    In: European Journal of Endocrinology, Oxford University Press (OUP), Vol. 189, No. 1 ( 2023-07-20), p. 106-114
    Abstract: To determine the clinical utility of assessment of tumour invasion, markers of proliferation, and the French clinicopathological classification in pituitary tumour prognostication. Methods This is a retrospective evaluation of adult patients undergoing pituitary surgery at Oxford University and St Vincent's Hospitals, between 1989 and 2016, with at least 12 months of clinical data. Invasion was assessed radiologically, proliferative markers (Ki67, mitotic count, p53) by immunohistochemistry. Tumours were graded according to the clinicopathological classification. Intra- and interlaboratory variability of histopathology reporting was evaluated. Outcomes (1) Tumour recurrence (radiological or reintervention ≥12 months postoperatively) and/or (2) “aggressive behaviour” (≥4 interventions and/or invasive tumour with recurrence/reintervention between 12 and 24 months postoperatively). Results A total of 386 patients were included, age at surgery was 56 (interquartile range [IQR] 41-67) years, 54% were male, and median follow-up was 90 months (range 44-126). Tumours were predominantly clinically nonfunctioning (252, 65%), with overall 53% invasive, and 10% that demonstrated ≥2 proliferative marker positivity. Recurrence was predicted by invasiveness (hazards ratio [HR] 1.6 [1.10-2.37], P .02), elevated mitotic count (HR 2.17 [1.21-3.89] , P .01), grade (2b vs 1a HR 2.32 [1.06-5.03], P .03), and absence of gross total rese ction (HR 3.70 [1.72-8.00], P .01). Clinically defined aggressiveness was associated with elevated Ki67, mitotic count, and invasiveness. Ki67 reporting methodologies showed moderate correlation across laboratories (Phi 0.620), whereas p53 reporting reproducibility was poor (Phi 0.146). Conclusions Proliferative markers, including Ki67 and mitotic count, but not p53, are important in predicting the development of aggressive pituitary tumour behaviour.
    Type of Medium: Online Resource
    ISSN: 0804-4643 , 1479-683X
    URL: Article
    DOI: 10.1093/ejendo/lvad079
    RVK:
    WA 15000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1485160-X
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  • 5
    Online Resource
    Online Resource
    Towards precision medicine for clinically non‐functioning pituitary tumours
    Wiley ; 2021
    In:  Clinical Endocrinology Vol. 95, No. 3 ( 2021-09), p. 398-409
    Details
    In: Clinical Endocrinology, Wiley, Vol. 95, No. 3 ( 2021-09), p. 398-409
    Abstract: Clinically non‐functioning pituitary tumours (NFPT) are a heterogenous group of neoplasms with diverse outcomes. The purpose of this narrative review was to summarize available data on predictive factors, both in routine practice and research settings. Design A literature review was conducted for papers published in peer‐reviewed journals, investigating clinical, radiological, pathological and genetic predictive factors in NFPT. Results Several clinical and radiological factors have been associated with NFPT recurrence and/or aggressiveness, including larger size and pre‐/post‐operative growth rates. Application of transcription factor immunohistochemistry has given rise to improved subtype identification, including ‘higher‐risk’ subtypes, in routine clinical practice. Numerous other pathological and genetic biomarkers have demonstrated promise for prognostication in the research setting. Conclusion NFPT are a heterogenous group of tumours, characterized by diverse presentation, pathogenesis and outcomes. Ongoing refinements in understanding of tumour biology are likely to pave the way to improved integrative prognostication and precision medicine for NFPT.
    Type of Medium: Online Resource
    ISSN: 0300-0664 , 1365-2265
    URL: Issue
    URL: Article
    DOI: 10.1111/cen.v95.3
    DOI: 10.1111/cen.14472
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2004597-9
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  • 6
    Online Resource
    Online Resource
    Pituitary tumours: molecular and genetic aspects
    Bioscientifica ; 2023
    In:  Journal of Endocrinology Vol. 257, No. 3 ( 2023-06-01)
    Details
    In: Journal of Endocrinology, Bioscientifica, Vol. 257, No. 3 ( 2023-06-01)
    Abstract: ‘Pituitary tumours’ is an umbrella term for various tumours originating from different regions of the hypothalamic–pituitary system. The vast majority of pituitary tumours are pituitary adenomas, also recently referred to as pituitary neuroendocrine tumours. The prevalence of clinically relevant pituitary adenomas is approximately 1 in 1000; other pituitary tumours such as craniopharyngioma and pituicytoma are comparatively very rare. This review addresses the molecular and genetic aspects of pituitary adenomas. We first discuss the germline genetic variants underlying familial pituitary tumours, which account for approximately 5% of all pituitary adenoma cases. This includes variants in established pituitary adenoma/hyperplasia predisposition genes ( MEN1 , PRKAR1A , AIP , CDKN1B , GPR101 , SDHA , SDHB , SDHC , SDHD , SDHAF2 ) as well as emerging genetic associations. In addition, we discuss McCune–Albright syndrome which lies between the germline and somatic pituitary tumour genes as the causative GNAS mutations are postzygotic rather than being inherited, and the condition is associated with multiglandular features due to the involvement of different cell lines rather than being limited to the pituitary. By contrast, somatic GNAS mutations contribute to sporadic acromegaly. USP8 is the only other gene where somatic driver mutations have been established in sporadic pituitary tumorigenesis. However, there are now known to be a variety of other somatic genetic and molecular changes underpinning sporadic pituitary adenomas which we review here, namely: copy number variation, molecular changes in signalling and hypoxia pathways, epithelial–mesenchymal transition, DNA repair, senescence, the immune microenvironment and epigenetics.
    Type of Medium: Online Resource
    ISSN: 0022-0795 , 1479-6805
    URL: Article
    DOI: 10.1530/JOE-22-0291
    Language: Unknown
    Publisher: Bioscientifica
    Publication Date: 2023
    detail.hit.zdb_id: 1474892-7
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  • 7
    Online Resource
    Online Resource
    Transcription Factor Immunohistochemistry in the Diagnosis of Pituitary Tumors
    The Endocrine Society ; 2021
    In:  Journal of the Endocrine Society Vol. 5, No. Supplement_1 ( 2021-05-03), p. A651-A651
    Details
    In: Journal of the Endocrine Society, The Endocrine Society, Vol. 5, No. Supplement_1 ( 2021-05-03), p. A651-A651
    Abstract: Objective: The clinical utility and prognostic value of WHO 2017 lineage-based classification of pituitary tumors have not been assessed. This study aimed to (1) To determine the clinical utility of transcription factor analysis for classification of pituitary tumors and (2) To determine the prognostic value of improved lineage-based classification of pituitary tumors. Methods: This was a retrospective evaluation of patients who underwent surgical resection of pituitary tumors at a tertiary referral centre between 1990 and 2016. Included patients were at least 18 years of age and had complete histopathological data, forming the “histological cohort”. Patients with at least 12 months of post-surgical follow up were included in the subgroup “clinical cohort”. The diagnostic efficacy of transcription factor immunohistochemistry in conjunction with hormone immunohistochemistry was compared with hormone immunohistochemistry alone. The prognostic value of identifying “higher risk” histological subtypes was assessed. Results: There were 172 patient tumor samples analyzed in the histological cohort. Of these, there were 96 patients forming the clinical cohort. Subtype diagnosis was changed in 24/172 (14%) of tumors. Within the clinical cohort, there were 21/96 (22%) patients identified with higher risk histological subtype tumors. These were associated with tumor invasiveness (p=0.032), early recurrence (12-24 months, p=0.016), shorter median time to recurrence (38 [IQR 20-68.5] v 15 [IQR 12-27.25] months, p=0.02) and reduced recurrence-free survival (p=0.023). Conclusions: Application of transcription factor analysis, in addition to hormone IHC, is associated with improved diagnostic information.
    Type of Medium: Online Resource
    ISSN: 2472-1972
    URL: Article
    DOI: 10.1210/jendso/bvab048.1327
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2021
    detail.hit.zdb_id: 2881023-5
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