Gender-related Differences in Pituitary Adenomas

Abstract

Pituitary adenomas account for about 10% of all intracranial neoplasms and for about 85% of all pituitary tumors. In addition, prospective studies of normal persons and postmortem examinations reveal pituitary adenomas in up to 10% of adults indicating that not all pituitary adenomas are clinically significant. With clinically significant pituitary adenomas, patients may present with hyper- or under-secretion of pituitary hormones or with symptoms and signs of space occupying intracranial tumor like headache and visual compromise. Like other differentiated neuroendocrine cells, the anterior pituitary displays remarkable plasticity in response to physiological demands, as exemplified by the lactotroph differentiation and proliferation of pregnancy or the thyrotroph hyperplasia of primary hypothyroidism. These reversible changes are mediated by a diverse array of signals that have been interpreted to support a role for hormonal stimulation in the pathogenesis of pituitary adenomas. Different investigators have shown a tendency to gender-related differences not only in surgical outcome, but also in the presenting symptoms and signs, duration of symptoms, tumor size, tumor histology, and restoration of normal pituitary function in patients who are surgically treated and histologically proven pituitary adenomas. In this review, we will try to give a systematic insight into gender related differences of pituitary adenomas. Special reference is given on potential different biology of these tumors as suggested by the gender related differences. The manuscript therefore gives new insights into the cellular understanding of the pituitary adenomas.

Key words

hormones - insufficiencies - signal transduction

References

• 1 Apel R, Asa S. Update in aspects of endocrine pathology.  Pathology International. 2004;  54 ((Suppl. 1)) S118-S127
• 2 Asa SL. Tumors of the Pituitary Gland Washington. DC: Armed Forces Institute of Pathology 1998
• 3 Buurman H, Saeger W. Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data.  Eur J Endocrinol. 2006;  154 753-758
• 4 Carter JN, Tyson JE, Tolis G. et al . Prolactin-secreting tumors and hypogonadism in 22 men.  N Engl J Med. 1978;  299 847-852
• 5 Colao A, Di Sarno A, Cappabianca P. et al . Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia.  Eur J Endocrinol. 2003;  148 325-331
• 6 Delgrange E, Trouillas J, Maiter D. et al . Sex-Related Difference in the Growth of Prolactinomas: A Clinical and Proliferation Marker Study.  J Clin Endocrinol Metab. 1999;  82 ((7)) 2102-2107
• 7 Ezzat S. Pituitary tumor pathogenesis – the hunt for novel candidate genes continues.  J Clin Endocrinol Metab. 2003;  88 5116-5118
• 8 Finelli P, Larizza L. Pituitary Adenomas: Atlas of Genetics and Cytogenetics. 2005; 
• 9 Garber JR, Hedley-Whyte ET. A 44-year-old woman with headache, blurred vision, and an intrasellar mass.  N Engl J Med. 1995;  333 441-447
• 10 Giraldi FP, Moro M, Cavagnini F. the study group on the hypothalamo-pituitary-adrenal axis of the italian society of endocrinology . Gender-Related Differences in the Presentation and Course of Cushing's Disease.  J Clin Endocrinol Metab. 2003;  88 ((4)) 1554-1558
• 11 Gürlek A, Karavitaki N, Ansorge O. et al . What are the markers of aggressiveness in prolactinomas Changes in cell biology, extracellular matrix components, angiogenesis and genetics.  Eur J Endocrinol. 2007;  156 ((Issue 2)) 143-153
• 12 Hall WA, Luciano MG, Doppman JL. et al . Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population.  Ann Intern Med. 1994;  120 817-820
• 13 Koranyi J, Bosaeus I, Alpsten M. et al . Body composition during GH replacement in adults – methodological variations with respect to gender.  Eur J Endocrinol. 2006;  154 545-553
• 14 Mindermann T, Wilson CB. Age-related and gender-related occurrence of pituitary adenomas.  Clin Endocrinol (Oxf). 1994 Sep;  41 ((3)) 359-364
• 15 Nishioka H, Haraoka J, Akada K. et al . Gender-related differences in prolactin secretion in pituitary prolactinomas.  Neuroradiology. 2002;  44 407-410
• 16 Nishioka H, Haraoka J, Akada K. Growth potential of prolactinomas in men: is it really different from women?.  Surg Neurol. 2003;  59 386-390
• 17 Pei L, Melmed S. Isolation and characterization of a pituitary tumor-transforming gene (PTTG).  Mol Endocrinol. 1997;  11 433-441
• 18 Saeger W, Ludecke DK, Buchfelder M. et al . Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry.  Eur J Endocrinol. 2007;  156 203-216
• 19 Schaller B, Kirsch E, Tolnay M. et al . Symptomatic granular cell tumor of the pituitary gland: case report and review of the literature.  Neurosurgery. 1998;  42 166-170
• 20 Schaller B. Gender related differences in non-functioning pituitary adenomas.  Neuro Endocrinol Letters. 2003;  24 ((6)) 425-430
• 21 Schaller B. Gender-Related Differences in Growth Hormone-Releasing Pituitary Adenomas. A Clinicopathological Study.  Pituitary. 2002;  5 247-253
• 22 Schaller B. Gender-related differences in prolactionomas. A clinicopathological study.  Neuroendcrinol Lett. 2005;  26 ((2)) 152-159
• 23 Scheithauer BW, Gaffey TA, Lloyd RV. et al . Pathobiology of pituitary adenomas and carcinomas.  Neurosurgery. 2006;  59 341-353
• 24 Schlechte J, Sherman B, Halmi N. et al . Prolactin-secreting pituitary tumors in amenorrheic women: a comprehensive study.  Endocr Rev. 1980;  1 295-308
• 25 Schlechte JA. Prolactinoma.  N Engl J Med. 2003;  349 2035-2041
• 26 Seizaburo S, Hitoshi T, Takeo F. et al . Biology of pituitary adenoma: an endocrinological, immunohistochemical and argyrophil nucleolar organizer region (Ag-NOR) studies with special reference to invasive adenoma.  Medical Bulletin of Fukuoka University. 2001;  28 77-88
• 27 Spada A, Lania A, Mantovani G. hormonal signaling and pituitary adenomas.  Neuroendocrinology. 2007;  85 101-109
• 28 Sylvia LA, Ezzat S. The cytogenesis and pathogenesis of pituitary adenomas.  Endocrine Reviews. 1998;  19 ((6)) 798-827
• 29 Tfelt-Hansen J, Kanuparthi D, Chattopadhyay N. The emerging role of pituitary tumors transforming gene in tumorigenesis.  Clin Med Res. 2006;  4 130-137
• 30 Zou H, McGarry TJ, Bernal T. et al . Identification of a vertebrate sister-chromatid separation inhibitor involved in transformation and tumorigenesis.  Science. 1999;  285 418-422

Correspondence