A proposed clinical classification for pituitary neoplasms to guide therapy and prognosis.

in The lancet. Diabetes & endocrinology by Ken K Y Ho, Maria Fleseriu, John Wass, Laurence Katznelson, Gerald Raverot, Andrew S Little, Justo P Castaño, Martin Reincke, M Beatriz Lopes, Ursula B Kaiser, Philippe Chanson, Mônica Gadelha, Shlomo Melmed

TLDR

  • A new approach for guiding prognosis and therapy of pituitary adenomas by integrating clinical, genetic, biochemical, radiological, pathological, and molecular information is proposed.

Abstract

No comprehensive classification system that guides prognosis and therapy of pituitary adenomas exists. The 2022 WHO histopathology-based classification system can only be applied to lesions that are resected, which represent few clinically significant pituitary adenomas. Many factors independent of histopathology provide mechanistic insight into causation and influence prognosis and treatment of pituitary adenomas. We propose a new approach to guide prognosis and therapy of pituitary adenomas by integrating clinical, genetic, biochemical, radiological, pathological, and molecular information for all adenomas arising from anterior pituitary cell lineages. The system uses an evidence-based scoring of risk factors to yield a cumulative score that reflects disease severity and can be used at the bedside to guide pituitary adenoma management. Once validated in prospective studies, this simple manageable classification system could provide a standardised platform for assessing disease severity, prognosis, and effects of therapy on pituitary adenomas.

Overview

  • The study aims to develop a new approach for guiding the prognosis and therapy of pituitary adenomas by integrating clinical, genetic, biochemical, radiological, pathological, and molecular information.
  • The proposed system uses an evidence-based scoring of risk factors to yield a cumulative score that reflects disease severity and can be used at the bedside to guide pituitary adenoma management.
  • The study aims to provide a standardized platform for assessing disease severity, prognosis, and effects of therapy on pituitary adenomas.

Comparative Analysis & Findings

  • The study highlights the limitations of the 2022 WHO histopathology-based classification system, which can only be applied to lesions that are resected, representing few clinically significant pituitary adenomas.
  • The proposed system integrates multiple factors independent of histopathology to provide mechanistic insight into causation and influence prognosis and treatment of pituitary adenomas.
  • The cumulative score generated by the system can be used to guide pituitary adenoma management and provide a standardized platform for assessing disease severity, prognosis, and effects of therapy.

Implications and Future Directions

  • The study has the potential to improve the classification and management of pituitary adenomas, leading to better patient outcomes.
  • Future studies are needed to validate the proposed system in prospective studies.
  • The system has the potential to be applied to other neuroendocrine tumors and could be used as a framework for developing standardized classification systems for these tumors.
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