The Pituitary Society reacts to the controversial reclassification of pituitary adenomas to neuroendocrine tumors

From J D Faccinetti, chief editor co-founder –  First, some background: the latest edition of the WHO (World Health Organization) Endocrine Tumors and Central Nervous System Tumors group reclassified pituitary adenomas as neuroendocrine tumors or NETs. This reclassification was based on a recommendation from an international group – The Pituitary Pathology Club – mainly based on an opinion piece from Dr. Sylvia Asa. You can hear Dr. Asa’s discussion on the subject in this exclusive Pituitary World News podcast or read Dr. Asa’s paper, “From pituitary adenoma to pituitary neuroendocrine tumor (PitNET): an international pituitary pathology club proposal.”  

The WHO Classification authorities use a pathology-based system to classify pituitary adenomas. Its 2022 edition argues certain cells of pituitary adenomas are members of a family of neuroendocrine tumors and, therefore, they should all be classified as such, consequently categorizing all pituitary adenomas as malignant.

Not so fast! The Pituitary Society reacted to the controversial reclassification of Adenomas to Neuroendocrine Tumors in a recent “perspective” paper. The group, comprised of international stakeholders, lays out the case for an integrated prognostic classification. 

The Pituitary Society “perspective” paper questions the reclassification and suggests that a comprehensive recommendation is needed, which should include clinical, genetic, biochemical, pathological, and other important markers. It expresses concern over this nomenclature change, explaining that a NET designation gives pituitary adenomas an oncology (cancer) label when, in fact, pituitary adenomas are overwhelmingly benign. It states the changes were implemented without clinical considerations; and while there are some similarities, unlike NETs, adenomas are slow-growing, and importantly, they rarely become malignant. There are clinical and health system implications that apparently were not considered appropriately by the group responsible for the change. 

Patient and advocacy groups have also asserted that it will likely complicate matters regarding treatment, diagnosis delays, access to care and medications, issues with insurance, and the ever-present potential anxiety when these adenomas are inevitably described as and grouped under an oncology designation.  

The Pituitary Society’s group “perspective paper” clearly states that “classification change of pituitary adenomas to NETs does not advance the management of pituitary adenomas. As a pathology-based classification system can only apply to resected lesions, a need exists for a comprehensive classification system that also includes the majority of pituitary adenomas that do not require surgery. “

We believe this issue is vital to all pituitary patients as it will likely affect how these diseases are perceived, diagnosed, and treated.  We urge you to read the paper and learn about the details and potential issues this nomenclature change could cause.

To share your opinion, please click on this link. 

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