CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(02): 377-382
DOI: 10.1055/s-0043-1768601
Case Report

Synchronous Posterior and Anterior Pituitary Tumors: A Case Report of a Hypothetic Paracrine Relationship

Franco Rubino
1   Department of Neurological Surgery, University of Miami, University of Miami Hospital, Miami, Florida, United States
Daniel G. Eichberg
1   Department of Neurological Surgery, University of Miami, University of Miami Hospital, Miami, Florida, United States
Ali G. Saad
2   Department of Pathology, University of Miami, University of Miami Hospital, Miami, Florida, United States
Ricardo J. Komotar
3   Sylvester Comprehensive Cancer Center, Miami, Florida, United States
Michael E. Ivan
3   Sylvester Comprehensive Cancer Center, Miami, Florida, United States
› Author Affiliations
Funding None.


Tumors of the posterior pituitary are a distinct group of low-grade sellar neoplasms. Furthermore, the coexistence with an anterior pituitary tumor is extremely unlikely and could not be a mere coincidence and could be a paracrine relationship. Here, we present a case of 41-year-old woman with Cushing syndrome and two pituitary masses on magnetic resonance imaging. Histologic examination shows two distinct lesions. The first consisted of a pituitary adenoma with intense adrenocorticotropic hormone immunostaining and the second lesion consisted of a proliferation of pituicytes arranged in vague fascicles or pituicytoma. After a narrative review of the literature, we found that synchronous pituitary adenoma and a thyroid transcription factor 1 (TTF-1) pituitary tumor were only reported eight times in the past. These patients included two granular cell tumors and six pituicytomas and all of them coexisted with pituitary adenomas, seven functioning and one nonfunctioning. We analyze the hypothesis of a possible paracrine relationship for this concomitance, but this exceedingly rare situation is still a matter of debate. To the best of our knowledge, our case represents the ninth case of a TTF-1 pituitary tumor coexisting with a pituitary adenoma.

Authors' Contributions

Ricardo J. Komotar had the idea for the article and perform the surgery with Michael E. Ivan. The literature search and data analysis were performed by Franco Rubino and Daniel Eichberg. The first draft of the manuscript was written by Franco Rubino and critically revised by Michael E. Ivan and Ali G. Saad. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethical Approval

Institutional review board approval was obtained for this study. The patient consent process was waived as this is a retrospective study stripped of all identifying information. Data collection was performed under the protocols of the Human Research Protection Office of our institution.

Publication History

Article published online:
07 June 2023

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