title: Preoperative identification of clearly separated double pituitary adenomas.
abstract: OBJECTIVE
  Double pituitary adenomas are extremely rare. They can be divided into contiguous and clearly separated types. Most contiguous tumours are surgically removed as one tumour and the co-existence of different adenoma types can be confirmed by histological methods. In contrast, detailed preoperative neuroimaging studies can suggest the co-existence of separated multiple adenomas. In patients with multiple adenomas, surgical failure may result when one adenoma is missed during surgery. Among 600 surgical cases we encountered four patients with clearly separated double pituitary adenomas; all were highly suspect on preoperative MRI studies.
  
  
  RESULTS
  All four patients manifested acromegalic symptoms; one patient also exhibited hyperprolactinemia and two had familial pituitary adenomas unrelated to multiple endocrine neoplasia type I (MEN-1). All underwent transsphenoidal surgery and histology confirmed the diagnosis of GH-producing plus gonadotroph adenoma in two cases and of two GH-producing adenomas each in the other two patients.
  
  
  CONCLUSIONS
  Although the pathogenesis of our double adenomas remains unknown, genetic abnormalities may be involved because two patients had familial pituitary adenomas unrelated to MEN-1. When preoperative MRI is suggestive of double adenomas, careful surgical exploration is necessary to avoid missing the other adenoma because the risk of surgical failure is high, especially in patients with functioning adenomas.
authors.affiliation: Department of Neurosurgery, Toranomon Hospital, Toranomom, Minato-ku, Tokyo, Japan. kyongson@nms.ac.jp
authors.forename: Kyongsong
authors.initials: K
authors.lastname: Kim
authors.forename: Shozo
authors.initials: S
authors.lastname: Yamada
authors.forename: Masaaki
authors.initials: M
authors.lastname: Usui
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Sano
mesh_terms: D000172:Acromegaly / Q000209:etiology / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D005260:Female; D037201:Follicle Stimulating Hormone, beta Subunit / Q000378:metabolism; D013006:Growth Hormone / Q000378:metabolism; D006801:Humans; D006966:Hyperprolactinemia / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D011388:Prolactin / Q000378:metabolism; D037322:Thyrotropin, beta Subunit / Q000378:metabolism
chemical_list: D037201:Follicle Stimulating Hormone, beta Subunit; D037322:Thyrotropin, beta Subunit; D011388:Prolactin; D013006:Growth Hormone