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  • Perspective
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Pituitary adenoma or neuroendocrine tumour: the need for an integrated prognostic classification

Nature Reviews Endocrinology volume 19, pages 671–678 (2023)Cite this article

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Abstract

In the 2022 fifth edition of the WHO Classification of Endocrine Tumours and of Central Nervous System Tumours, pituitary adenomas are reclassified as neuroendocrine tumours (NETs). This change confers an oncology label to neoplasms that are overwhelmingly benign. A comprehensive clinical classification schema is required to guide prognosis, therapy and outcomes for all patients with pituitary adenomas. Pituitary adenomas and NETs exhibit some morphological and ultrastructural similarities. However, unlike NETs, pituitary adenomas are highly prevalent, yet indolent and rarely become malignant. This Perspective presents the outcomes of an interdisciplinary international workshop that addressed the merit and clinical implications of the classification change of pituitary adenoma to NET. Many non-histological factors provide mechanistic insight and influence the prognosis and treatment of pituitary adenoma. We recommend the development of a comprehensive classification that integrates clinical, genetic, biochemical, radiological, pathological and molecular information for all anterior pituitary neoplasms.

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Fig. 1: Comparing the epidemiology of pituitary neoplasms and neuroendocrine tumours.

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Acknowledgements

The PANOMEN 2 workshop was sponsored by The Pituitary Society with no commercial support. We thank M. Beatriz S. Lopes, University of Virginia, Charlottesville, VA, USA, and Olivera Casar-Borota, Uppsala University Hospital, Uppsala, Sweden, for participating in the discussions.

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Authors and Affiliations

  1. The Garvan Institute of Medical Research, Sydney, New South Wales, Australia

    Ken K. Y. Ho

  2. The University of New South Wales, Sydney, New South Wales, Australia

    Ken K. Y. Ho

  3. Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Ursula B. Kaiser

  4. Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France

    Phillippe Chanson

  5. Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Monica Gadelha

  6. Churchill Hospital, Oxford, UK

    John Wass

  7. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA

    Lynnette Nieman

  8. Barrow Neurological Institute, Phoenix, AZ, USA

    Andrew Little & Kevin C. J. Yuen

  9. University of California, San Francisco, San Francisco, CA, USA

    Manish K. Aghi & Laura Esserman

  10. University of Illinois Urbana-Champaign, Urbana, IL, USA

    Lori Raetzman

  11. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Kalmon Post

  12. Hospices Civils de Lyon, Groupement Hospitalier Est, Université Claude Bernard Lyon 1, Bron, France

    Gerald Raverot

  13. University of California at Davis School of Medicine, Davis, CA, USA

    Alexander D. Borowsky

  14. Mayo Clinic, Rochester, MN, USA

    Dana Erickson

  15. Maimónides Biomedical Research Institute of Córdoba, University of Córdoba, Córdoba, Spain

    Justo P. Castaño

  16. Reina Sofia University Hospital, Córdoba, Spain

    Justo P. Castaño

  17. Brigham and Women’s Hospital, Boston, MA, USA

    Edward R. Laws

  18. University of Ferrara, Ferrara, Italy

    Maria Chiara Zatelli

  19. The Acromegaly Community, Grove, OK, USA

    Jill Sisco

  20. University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ, USA

    Kevin C. J. Yuen

  21. Klinikum der Universität, Ludwig-Maximilians-Universität, München, Germany

    Martin Reincke

  22. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Shlomo Melmed

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Contributions

A.D.B., P.C., L.E., L.N., G.R., L.R., M.R., J.S. and J.W. researched data for the article. All authors contributed substantially to discussion of the content. K.H. and S.M. wrote the article. All authors reviewed and/or edited the manuscript before submission.

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Correspondence to Ken K. Y. Ho.

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Nature Reviews Endocrinology thanks Nienke Biermasz and Gherardo Mazziotti for their contribution to the peer review of this work.

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Related links

Acromegaly Community: https://acromegalycommunity.org

NETs: http://www.mayoclinic.org/syc-20354132

WHO Family of International Classifications: https://www.who.int/standards/classifications

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Ho, K.K.Y., Kaiser, U.B., Chanson, P. et al. Pituitary adenoma or neuroendocrine tumour: the need for an integrated prognostic classification. Nat Rev Endocrinol 19, 671–678 (2023). https://doi.org/10.1038/s41574-023-00883-8

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