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Somatotroph adenoma(PITA1)

MedGen UID:
1618709
Concept ID:
C4538355
Neoplastic Process
Synonyms: ACROMEGALY DUE TO PITUITARY ADENOMA 1; ISOLATED FAMILIAL SOMATOTROPINOMA; PITA1; PITUITARY ADENOMA 1, MULTIPLE TYPES; Pituitary adenoma, growth hormone-secreting; Pituitary tumor, growth hormone-secreting, somatic; SOMATOTROPHINOMA, FAMILIAL
 
Gene (location): AIP (11q13.2)
 
Monarch Initiative: MONDO:0007052
OMIM®: 102200

Disease characteristics

Excerpted from the GeneReview: AIP Familial Isolated Pituitary Adenomas
AIP familial isolated pituitary adenoma (AIP-FIPA) is defined as the presence of an AIP germline pathogenic variant in an individual with a pituitary adenoma (regardless of family history). The most commonly occurring pituitary adenomas in this disorder are growth hormone-secreting adenomas (somatotropinoma), followed by prolactin-secreting adenomas (prolactinoma), growth hormone and prolactin co-secreting adenomas (somatomammotropinoma), and nonfunctioning pituitary adenomas (NFPA). Rarely TSH-secreting adenomas (thyrotropinomas) are observed. Clinical findings result from excess hormone secretion, lack of hormone secretion, and/or mass effects (e.g., headaches, visual field loss). Within the same family, pituitary adenomas can be of the same or different type. Age of onset in AIP-FIPA is usually in the second or third decade. [from GeneReviews]
Authors:
Márta Korbonits  |  Ajith V Kumar   view full author information

Additional description

From OMIM
Mutations in the AIP gene have been found predominantly in growth hormone (GH)-secreting adenomas, but have also been found in adrenocorticotropic hormone (ACTH)-secreting, thyroid hormone (TSH)-secreting, and prolactin (PRL)-secreting pituitary tumors. Pituitary adenomas are benign monoclonal neoplasms of the anterior pituitary gland, accounting for approximately 15% of intracranial tumors. Growth hormone (139250)-secreting adenomas, also known as somatotropinomas, which clinically result in acromegaly, comprise about 20% of all pituitary tumors and are the second most common hormone-secreting pituitary tumor after prolactin (176760)-secreting tumors, which account for 40 to 45% of pituitary tumors. ACTH-secreting tumors, which result in Cushing disease, and thyrotropin (TSHB; 188540)-secreting tumors are much less common. Nonsecreting pituitary tumors, which account for about 33%, can cause symptoms due to local compressive effects of tumor growth (Vierimaa et al., 2006; Georgitsi et al., 2007; Horvath and Stratakis, 2008). Acromegaly is characterized by coarse facial features, protruding jaw, and enlarged extremities (Vierimaa et al., 2006). Familial isolated somatotropinoma (FIS) is defined as the occurrence of at least 2 cases of acromegaly or gigantism in a family that does not exhibit features of other endocrine syndromes. FIS patients tend to have onset about 4 to 10 years earlier than patients with sporadic disease (Gadelha et al., 1999; Horvath and Stratakis, 2008). Cushing disease is characterized by central obesity, moon facies, diabetes, 'buffalo hump,' hypertension, fatigue, easy bruising, depression, and reproductive disorders. Cushing disease is associated with increased morbidity and mortality, mainly due to cardiovascular or cerebrovascular disease and infections (summary by Perez-Rivas et al., 2015). Familial isolated pituitary adenoma (FIPA) and pituitary adenoma predisposition (PAP) are terms referring to families in which 2 or more individuals develop pituitary tumors. Within a family, tumor types can be heterogeneous, with members of the same family having GH-secreting, prolactin-secreting, ACTH-secreting, or nonsecreting adenomas; in contrast, some families are homogeneous with regard to tumor type. Familial isolated somatotropinoma refers specifically to GH-secreting tumors and is usually associated with an acromegaly phenotype. Thus, FIS is a subset of FIPA or PAP (Toledo et al., 2007). Schlechte (2003) discussed prolactinoma in general terms as a clinical, diagnostic, and therapeutic problem. Genetic Heterogeneity of Pituitary Adenomas Also see pituitary adenoma-2 (PITA2; 300943), caused by mutation in the GPR101 gene (300393); pituitary adenoma-3 (PITA3; 617686), caused by somatic activating mutations in the GNAS1 gene (139320); pituitary adenoma-4 (PITA4; 219090), caused by somatic mutation in the USP8 gene (603158); and pituitary adenoma-5 (PITA5; 617540), caused by mutation in the CDH23 gene (605516). Patients with the chromosome Xq26.3 microduplication syndrome (300942) have growth hormone-secreting adenomas. Familial acromegaly can also occur in association with multiple endocrine neoplasia type I (MEN1; 131100), Carney complex (CNC1; 160980), and the McCune-Albright syndrome (174800). Rostomyan et al. (2015) performed a retrospective analysis of 208 patients with pituitary gigantism due to pituitary adenoma or hyperplasia. Most patients (78.4%) were male, and the median onset of rapid growth was 13 years of age for boys and 11 years for girls. Of the 143 patients who consented to genetic testing, 29% had AIP mutations, and microduplication at Xq26.3 (XLAG; 300942) was present in 2 familial isolated pituitary adenoma kindreds and in 10 sporadic patients. Rostomyan et al. (2015) noted that no genetic etiology was identified in more than 50% of the cases, and that the genetically unexplained cases showed more aggressive disease in terms of invasion, hormone levels, and lower control rates.  http://www.omim.org/entry/102200

Clinical features

From HPO
Pituitary adenoma
MedGen UID:
45933
Concept ID:
C0032000
Neoplastic Process
A benign epithelial tumor derived from intrinsic cells of the adenohypophysis (anterior pituitary).
Prolactin-producing pituitary gland adenoma
MedGen UID:
10936
Concept ID:
C0033375
Neoplastic Process
AIP familial isolated pituitary adenoma (AIP-FIPA) is defined as the presence of an AIP germline pathogenic variant in an individual with a pituitary adenoma (regardless of family history). The most commonly occurring pituitary adenomas in this disorder are growth hormone-secreting adenomas (somatotropinoma), followed by prolactin-secreting adenomas (prolactinoma), growth hormone and prolactin co-secreting adenomas (somatomammotropinoma), and nonfunctioning pituitary adenomas (NFPA). Rarely TSH-secreting adenomas (thyrotropinomas) are observed. Clinical findings result from excess hormone secretion, lack of hormone secretion, and/or mass effects (e.g., headaches, visual field loss). Within the same family, pituitary adenomas can be of the same or different type. Age of onset in AIP-FIPA is usually in the second or third decade.
Pituitary growth hormone cell adenoma
MedGen UID:
866320
Concept ID:
C4018860
Neoplastic Process
A type of pituitary adenoma that produces growth hormone.
Irregular menstruation
MedGen UID:
56379
Concept ID:
C0156404
Finding
Abnormally high variation in the amount of time between periods.
Hypertensive disorder
MedGen UID:
6969
Concept ID:
C0020538
Disease or Syndrome
The presence of chronic increased pressure in the systemic arterial system.
Left ventricular hypertrophy
MedGen UID:
57442
Concept ID:
C0149721
Disease or Syndrome
Enlargement or increased size of the heart left ventricle.
Cardiomyopathy
MedGen UID:
209232
Concept ID:
C0878544
Disease or Syndrome
A myocardial disorder in which the heart muscle is structurally and functionally abnormal, in the absence of coronary artery disease, hypertension, valvular disease and congenital heart disease sufficient to cause the observed myocardial abnormality.
Acral overgrowth
MedGen UID:
1789172
Concept ID:
C1735881
Disease or Syndrome
Excessive growth of hands and feet (predominantly due to soft tissue swelling). Typical manifestations include shoe size increase, foot enlargement, glove tightness, and hand enlargement.
Increased circulating prolactin concentration
MedGen UID:
1702649
Concept ID:
C5200994
Finding
The presence of abnormally increased levels of prolactin in the blood. Prolactin is a peptide hormone produced by the anterior pituitary gland that plays a role in breast development and lactation during pregnancy.
Coarse facial features
MedGen UID:
335284
Concept ID:
C1845847
Finding
Absence of fine and sharp appearance of brows, nose, lips, mouth, and chin, usually because of rounded and heavy features or thickened skin with or without thickening of subcutaneous and bony tissues.
Elevated circulating growth hormone concentration
MedGen UID:
66732
Concept ID:
C0235986
Finding
Acromegaly is a condition resulting from overproduction of growth hormone by the pituitary gland in persons with closed epiphyses, and consists chiefly in the enlargement of the distal parts of the body. The circumference of the skull increases, the nose becomes broad, the tongue becomes enlarged, the facial features become coarsened, the mandible grows excessively, and the teeth become separated. The fingers and toes grow chiefly in thickness.
Increased circulating insulin-like growth factor 1 concentration
MedGen UID:
390982
Concept ID:
C2676198
Finding
An elevated level of insulin-like growth factor 1 (IGF1) in the blood circulation.
Galactorrhea not associated with childbirth
MedGen UID:
115998
Concept ID:
C0235660
Disease or Syndrome
Spontaneous flow of milk from the breast, unassociated with childbirth or nursing.

Professional guidelines

PubMed

Brue T, Rahabi H, Barry A, Barlier A, Bertherat J, Borson-Chazot F, Castinetti F, Cazabat L, Chabre O, Chevalier N, Christin-Maitre S, Cortet C, Drui D, Kamenicky P, Lançon C, Lioté F, Pellegrini I, Reynaud R, Salenave S, Tauveron I, Touraine P, Vantyghem MC, Vergès B, Vezzosi D, Villa C, Raverot G, Coutant R, Chanson P, Albarel F
Ann Endocrinol (Paris) 2023 Dec;84(6):697-710. Epub 2023 Aug 12 doi: 10.1016/j.ando.2023.08.003. PMID: 37579837
Puig-Domingo M, Bernabéu I, Picó A, Biagetti B, Gil J, Alvarez-Escolá C, Jordà M, Marques-Pamies M, Soldevila B, Gálvez MA, Cámara R, Aller J, Lamas C, Marazuela M
Front Endocrinol (Lausanne) 2021;12:648411. Epub 2021 Mar 16 doi: 10.3389/fendo.2021.648411. PMID: 33796079Free PMC Article
Shanik MH
Endocr Pract 2016 Feb;22(2):210-9. Epub 2015 Oct 5 doi: 10.4158/EP15825.RA. PMID: 26437214

Recent clinical studies

Etiology

Paul P, Banerjee M
World Neurosurg 2023 Jul;175:e1237-e1245. Epub 2023 Apr 30 doi: 10.1016/j.wneu.2023.04.104. PMID: 37427703
Lian X, Shen J, Gu Z, Yan J, Sun S, Hou X, You H, Xing B, Zhu H, Shen J, Zhang F
J Clin Endocrinol Metab 2020 Dec 1;105(12) doi: 10.1210/clinem/dgaa651. PMID: 32930785
Lv L, Jiang Y, Yin S, Hu Y, Chen C, Ma W, Jiang S, Zhou P
Endocrine 2019 Nov;66(2):310-318. Epub 2019 Jul 31 doi: 10.1007/s12020-019-02029-1. PMID: 31368083
Mete O, Lopes MB
Endocr Pathol 2017 Sep;28(3):228-243. doi: 10.1007/s12022-017-9498-z. PMID: 28766057
Shanik MH
Endocr Pract 2016 Feb;22(2):210-9. Epub 2015 Oct 5 doi: 10.4158/EP15825.RA. PMID: 26437214

Diagnosis

Brue T, Rahabi H, Barry A, Barlier A, Bertherat J, Borson-Chazot F, Castinetti F, Cazabat L, Chabre O, Chevalier N, Christin-Maitre S, Cortet C, Drui D, Kamenicky P, Lançon C, Lioté F, Pellegrini I, Reynaud R, Salenave S, Tauveron I, Touraine P, Vantyghem MC, Vergès B, Vezzosi D, Villa C, Raverot G, Coutant R, Chanson P, Albarel F
Ann Endocrinol (Paris) 2023 Dec;84(6):697-710. Epub 2023 Aug 12 doi: 10.1016/j.ando.2023.08.003. PMID: 37579837
Brownlee BP, Mann D, Glenn C, McKinney KA
Otolaryngol Clin North Am 2022 Apr;55(2):343-350. doi: 10.1016/j.otc.2021.12.015. PMID: 35365312
Lian X, Shen J, Gu Z, Yan J, Sun S, Hou X, You H, Xing B, Zhu H, Shen J, Zhang F
J Clin Endocrinol Metab 2020 Dec 1;105(12) doi: 10.1210/clinem/dgaa651. PMID: 32930785
Shanik MH
Endocr Pract 2016 Feb;22(2):210-9. Epub 2015 Oct 5 doi: 10.4158/EP15825.RA. PMID: 26437214
Daughaday WH
Endocrinol Metab Clin North Am 1992 Sep;21(3):633-47. PMID: 1521516

Therapy

Vuong HG, Dunn IF
Pituitary 2023 Dec;26(6):653-659. Epub 2023 Sep 21 doi: 10.1007/s11102-023-01353-0. PMID: 37735314
Brue T, Rahabi H, Barry A, Barlier A, Bertherat J, Borson-Chazot F, Castinetti F, Cazabat L, Chabre O, Chevalier N, Christin-Maitre S, Cortet C, Drui D, Kamenicky P, Lançon C, Lioté F, Pellegrini I, Reynaud R, Salenave S, Tauveron I, Touraine P, Vantyghem MC, Vergès B, Vezzosi D, Villa C, Raverot G, Coutant R, Chanson P, Albarel F
Ann Endocrinol (Paris) 2023 Dec;84(6):697-710. Epub 2023 Aug 12 doi: 10.1016/j.ando.2023.08.003. PMID: 37579837
Giustina A, di Filippo L, Uygur MM, Frara S
Endocrine 2023 May;80(2):303-307. Epub 2023 Feb 15 doi: 10.1007/s12020-023-03317-7. PMID: 36790521
Puig-Domingo M, Bernabéu I, Picó A, Biagetti B, Gil J, Alvarez-Escolá C, Jordà M, Marques-Pamies M, Soldevila B, Gálvez MA, Cámara R, Aller J, Lamas C, Marazuela M
Front Endocrinol (Lausanne) 2021;12:648411. Epub 2021 Mar 16 doi: 10.3389/fendo.2021.648411. PMID: 33796079Free PMC Article
Shanik MH
Endocr Pract 2016 Feb;22(2):210-9. Epub 2015 Oct 5 doi: 10.4158/EP15825.RA. PMID: 26437214

Prognosis

Vuong HG, Dunn IF
Pituitary 2023 Dec;26(6):653-659. Epub 2023 Sep 21 doi: 10.1007/s11102-023-01353-0. PMID: 37735314
Giustina A, di Filippo L, Uygur MM, Frara S
Endocrine 2023 May;80(2):303-307. Epub 2023 Feb 15 doi: 10.1007/s12020-023-03317-7. PMID: 36790521
Swanson AA, Erickson D, Donegan DM, Jenkins SM, Van Gompel JJ, Atkinson JLD, Erickson BJ, Giannini C
Pituitary 2021 Apr;24(2):192-206. Epub 2020 Oct 19 doi: 10.1007/s11102-020-01096-2. PMID: 33074402
Lian X, Shen J, Gu Z, Yan J, Sun S, Hou X, You H, Xing B, Zhu H, Shen J, Zhang F
J Clin Endocrinol Metab 2020 Dec 1;105(12) doi: 10.1210/clinem/dgaa651. PMID: 32930785
Lv L, Jiang Y, Yin S, Hu Y, Chen C, Ma W, Jiang S, Zhou P
Endocrine 2019 Nov;66(2):310-318. Epub 2019 Jul 31 doi: 10.1007/s12020-019-02029-1. PMID: 31368083

Clinical prediction guides

Giustina A, di Filippo L, Uygur MM, Frara S
Endocrine 2023 May;80(2):303-307. Epub 2023 Feb 15 doi: 10.1007/s12020-023-03317-7. PMID: 36790521
Swanson AA, Erickson D, Donegan DM, Jenkins SM, Van Gompel JJ, Atkinson JLD, Erickson BJ, Giannini C
Pituitary 2021 Apr;24(2):192-206. Epub 2020 Oct 19 doi: 10.1007/s11102-020-01096-2. PMID: 33074402
Lian X, Shen J, Gu Z, Yan J, Sun S, Hou X, You H, Xing B, Zhu H, Shen J, Zhang F
J Clin Endocrinol Metab 2020 Dec 1;105(12) doi: 10.1210/clinem/dgaa651. PMID: 32930785
Ben-Shlomo A, Deng N, Ding E, Yamamoto M, Mamelak A, Chesnokova V, Labadzhyan A, Melmed S
J Clin Invest 2020 Nov 2;130(11):5738-5755. doi: 10.1172/JCI138540. PMID: 32673291Free PMC Article
Lv L, Jiang Y, Yin S, Hu Y, Chen C, Ma W, Jiang S, Zhou P
Endocrine 2019 Nov;66(2):310-318. Epub 2019 Jul 31 doi: 10.1007/s12020-019-02029-1. PMID: 31368083

Recent systematic reviews

Gil J, Jordà M, Soldevila B, Puig-Domingo M
Front Endocrinol (Lausanne) 2021;12:646210. Epub 2021 Mar 15 doi: 10.3389/fendo.2021.646210. PMID: 33790868Free PMC Article

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