Double Pituitary Adenomas Are Most Commonly Associated with GH- and ACTH-Secreting Tumors: Systematic Review of the Literature

Background Double adenomas in the pituitary gland are a rare occurrence. The ability to cure a hormone-producing adenoma with surgery is dependent on the ability to identify and completely remove the correct adenoma. The relative frequency of each subtype of hormone-secreting adenomas confirmed with magnetic resonance image (MRI), surgery, and immunohistochemistry is not defined.

Methods Following PRISMA guidelines, we performed a systematic review of PubMed Central, Google Scholar, Scopus Database, Cochrane database, and Science Research, using the keywords: “double pituitary adenomas,” “multiple pituitary adenomas,” and only articles where multiple or truly separate double pituitary adenomas were identified presurgically by MRI and/or confirmed by pathology/immunohistochemistry staining were included.

Results We reviewed articles from 1975 to 2016, and found 17 cases with two pituitary adenomas and one with three pituitary adenomas. The ages ranged from 22 to 67 years, and there were eight females and six males. Immunohistochemical staining showed that the most common double pituitary adenomas were growth hormone (GH) followed by adrenocorticotropic hormone (ACTH) secreting.

Conclusion Double pituitary adenomas are rare but most commonly found with GH- or ACTH-producing tumors. It is critical to remove all identified possible adenomas to achieve biochemical cure and clinicians should have heightened sensitivity in patients with acromegaly or Cushing’s disease.