Gender-related differences in pituitary adenomas

Pituitary adenomas account for about 10% of all intracranial neoplasms and for about 85% of all pituitary tumors. In addition, prospective studies of normal persons and postmortem examinations reveal pituitary adenomas in up to 10% of adults indicating that not all pituitary adenomas are clinically significant. With clinically significant pituitary adenomas, patients may present with hyper- or under-secretion of pituitary hormones or with symptoms and signs of space occupying intracranial tumor like headache and visual compromise. Like other differentiated neuroendocrine cells, the anterior pituitary displays remarkable plasticity in response to physiological demands, as exemplified by the lactotroph differentiation and proliferation of pregnancy or the thyrotroph hyperplasia of primary hypothyroidism. These reversible changes are mediated by a diverse array of signals that have been interpreted to support a role for hormonal stimulation in the pathogenesis of pituitary adenomas. Different investigators have shown a tendency to gender-related differences not only in surgical outcome, but also in the presenting symptoms and signs, duration of symptoms, tumor size, tumor histology, and restoration of normal pituitary function in patients who are surgically treated and histologically proven pituitary adenomas. In this review, we will try to give a systematic insight into gender related differences of pituitary adenomas. Special reference is given on potential different biology of these tumors as suggested by the gender related differences. The manuscript therefore gives new insights into the cellular understanding of the pituitary adenomas.