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formation is endocrine end-organ failure, as occurs, for example, with ovarian atrophy that induces a basophilic adenoma Only a small proportion (6 to 8 percent) enlarge the sella, ie, most are microadenomas as discussed below On the basis of conventional hematoxylin-eosin staining methods, cells of the normal pituitary gland were for many years classi ed as chromophobe, acidophil, and basophil, these types being present in a ratio of 5:4:1 Adenomas of the pituitary are most often composed of chromophobe cells (4 to 20 times as common as acidophilcell adenomas); the incidence of basophil-cell adenomas is uncertain Histologic study is now based on immunoperoxidase staining techniques that de ne the nature of the hormones within the pituitary cells both of the normal gland and of pituitary adenomas These methods have shown that either a chromophobe or an acidophil cell may produce prolactin, growth hormone (GH), and thyroid-stimulating hormone (TSH), whereas the basophil cells produce adrenocorticotropic hormone (ACTH), beta-lipotropin, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) The development of sensitive (radioimmunoassay) methods for the measurement of pituitary hormones in the serum has made possible the detection of adenomas at an early stage of their development and the designation of several types of pituitary adenomas on the basis of the endocrine disturbance Hormonal tests for the detection of pituitary adenomas, preferably carried out in an endocrine clinic, are listed in Table 31-3 Between 60 and 70 percent of tumors, in both men and women, are prolactin-secreting About 10 to 15 percent secrete growth hormone, and a smaller number secrete ACTH Tumors that secrete gonadotropins and TSH are quite rare These tumors may be monohormonal or plurihormonal and approximately one-third are composed of nonfunctional (null) cells Pituitary tumors usually arise as discrete nodules in the anterior part of the gland (adenohypophysis) They are reddish gray, soft (almost gelatinous), and often partly cystic, with a rim of calcium in some instances The adenomatous cells are arranged diffusely or in various patterns, with little stroma and few blood vessels; less frequently the architecture is sinusoidal or papillary in type Variability of nuclear structure, hyperchromatism, cellular pleomorphism, and mitotic gures are interpreted as signs of maTable 31-3 Hormonal tests for detection of pituitary adenomas.

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Serum prolactin level, chlorpromazine- or TRH-provocative tests, L-dopa suppression Serum GH level, glucagon, L-dopa, glucoseGH suppression, somatomicid C Serum cortisol, urinary steroids, metyrapone test, dexamethasone suppression Serum FSH, LH, estradiol, testosterone, GnRH stimulation TSH, T4, TRH Urine and serum osmolality after water restriction for de ciency of hormone; without water restriction for excess of hormone

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Key: FSH, follicle-stimulating hormone; LH, luteinizing hormone; GnRH, gonadotropin-releasing hormone; TRH, thyrotropin-releasing hormone; T4, thyroxine; TSH, thyroid-stimulating hormone; GH, growth hormone

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