title: Multiple pituitary adenomas in Cushing's disease.
abstract: OBJECTIVE
  Clinically evident multiple pituitary adenomas rarely occur. The authors assess the incidence and clinical relevance of multiple adenomas in Cushing's disease.
  
  
  METHODS
  A prospective clinical database of 660 pituitary surgeries was analyzed to assess the incidence of multiple pituitary adenomas in Cushing's disease. Relevant radiographic scans, medical records, and histopathological reports were reviewed. Thirteen patients with at least two separate histopathologically confirmed pituitary adenomas were identified. Prolactinomas (nine patients) were the most common incidental tumors. Other incidental tumors included secretors of growth hormone ([GH], one patient) and GH and prolactin (two patients), and a null-cell tumor (one patient). In two patients, early repeated surgery was performed because the initial operation failed to correct hypercortisolism, in one instance because the tumor excised at the initial surgery was a prolactinoma, not an adrenocorticotropic hormone-secreting tumor. One patient had three distinct tumors.
  
  
  CONCLUSIONS
  Multiple pituitary adenomas are rare, but may complicate management of patients with pituitary disease.
authors.affiliation: Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: J K
authors.initials: JK
authors.lastname: Ratliff
authors.forename: E H
authors.initials: EH
authors.lastname: Oldfield
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D003480:Cushing Syndrome / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017591:Petrosal Sinus Sampling; D010911:Pituitary Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011388:Prolactin / Q000378:metabolism; D015175:Prolactinoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D019382:Human Growth Hormone; D000324:Adrenocorticotropic Hormone; D011388:Prolactin