Plurihormonal Pituitary Tumor of Pit-1 and SF-1 Lineages, with Synchronous Collision Corticotroph Tumor: a Possible Stem Cell Phenomenon

  • Karen M. Tordjman
  • Yona Greenman
  • Zvi Ram
  • Dov Hershkovitz
  • Orna Aizenstein
  • Ofra Ariel
  • Sylvia L. Asa


Thyrotropin (TSH)-secreting pituitary tumors are the rarest functioning pituitary tumors. Nonetheless, they are not infrequently plurihormonal, as they may express/secrete hormones made by other pituitary cells derived from the Pit-1 lineage such as growth hormone (GH), prolactin (PRL), and α-subunit (αSU). However, adrenocorticotropin (ACTH) or gonadotropin secretion by such a tumor is exceptional. Although double pituitary tumors are rare, they often combine ACTH and GH secretion. A 41-year-old presented almost 2 years after delivering her 10th child; she had thyrotoxicosis (goiter and palpitations) masquerading as autoimmune postpartum thyroiditis. She was still breastfeeding and amenorrheic. She proved to have TSH, GH, PRL, and ACTH hypersecretion. Imaging revealed an invasive pituitary macrotumor. She had stigmata neither of Cushing’s disease nor of acromegaly. Prior to surgery, hormonal control was achieved for close to 1 year by combined octreotide and cabergoline treatment with significant shrinking of the tumor. Following surgery, pathology revealed a collision tumor; the dominant lesion was positive for GH, βTSH, βFSH, and αSU and expressed both Pit-1 and SF-1.The smaller lesion was a corticotroph tumor. We report an unusual plurihormonal tumor co-expressing Pit-1 and SF-1 along with hormones made by cells of both lineages. Its simultaneous occurrence adjacent to a corticotroph tumor raises questions regarding the pathogenesis of these tumors. We propose the possibility of a stem cell tumor with multiple lineage differentiation. We hypothesize that pregnancy might have played a permissive role in tumorigenesis.


Pituitary tumor SF-1 Pit-1 Stem cell Collision Double tumor Plurihormonal 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

The patient gave her consent to have the case reported; there are no details in the manuscript that could allow identification.


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Authors and Affiliations

  1. 1.Institute of Endocrinology, Metabolism and HypertensionTel Aviv Sourasky Medical CenterTel AvivIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Department of NeurosurgeryTel Aviv Sourasky Medical CenterTel AvivIsrael
  4. 4.Institute of PathologyTel Aviv Sourasky Medical CenterTel AvivIsrael
  5. 5.Department of RadiologyTel Aviv Sourasky Medical CenterTel AvivIsrael
  6. 6.Maccabi Health ServicesTel AvivIsrael
  7. 7.Department of Pathology, Laboratory Medicine ProgramUniversity Health NetworkTorontoCanada
  8. 8.Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoCanada

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