Pituitary Tumors Associated with Acromegaly1

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Abstract
Pituitary adenomas from 50 patients with acromegaly were studied cytologically. Bio-assay for growth hormone activity was performed in 6 of these. The adenomas were classified into 2 distinct groups and designated as typical (6 cases) and atypical (44 cases) adenomas of acromegaly. Typical adenomas were composed of well-granulated acidophils, and the 2 tumors that were bioassayed had a relatively high concentration of growth hormone activity. All 6 typical adenomas were small intrasellar tumors that produced no visual field defects and which were found at necropsy in elderly patients, usually males, with well-developed acral overgrowth. Death in these cases was incidental to the tumor, being most often of cardiovascular origin. The atypical adenomas were a heterogeneous group of larger pituitary tumors composed of moderately or sparsely granulated acidophils and agranular cells that were indistinguishable from chromophobes. The concentration of growth hormone activity was relatively low in 3 of the 4 tumor assays. Many atypical adenomas were morphologically indistinguishable from chromophobe adenomas not associated with acromegaly. These atypical adenomas were found most often at surgery for visual loss and were noted in middle-aged patients; the distribution of sexes was equal. As a group, these tumors were characterized by aggressive local growth and by a tendency to recur. The degree of acral overgrowth was variable. No evidence of transition between the 2 adenoma types was found in the 5 patients whose tissues were examined at various intervals, up to 14 years apart.

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