• Eur. J. Intern. Med. · Nov 2019

    Multicenter Study

    3P association (3PAs): Pituitary adenoma and pheochromocytoma/paraganglioma. A heterogeneous clinical syndrome associated with different gene mutations.

    • Fernando Guerrero-Pérez, Carmen Fajardo, Elena Torres Vela, Olga Giménez-Palop, Arturo Lisbona Gil, Tomas Martín, Natividad González, Juan José Díez, Pedro Iglesias, Mercedes Robledo, and Carles Villabona.
    • Department of Endocrinology, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: fguerrerop@bellvitgehospital.cat.
    • Eur. J. Intern. Med. 2019 Nov 1; 69: 14-19.

    BackgroundPituitary adenomas (PA) associated with pheochromocytomas/paragangliomas (Pheo/PGL), also known as "the three P association" or "3PAs" could be the results of coincidence, but new evidence supports a common pathogenic mechanism in some patients. Our aim is to report the clinical data, surgical outcome, genetic findings of a large case series and review the current knowledge on this topic.Methods And ResultsIn a retrospective multicentre study, we compiled 10 patients with PAs (6 new unreported cases). Six patients were female with mean age of 51.6 ± 18.0 years. PA were: 6 acromegaly, 3 prolactinoma and 1 non-functioning PA (NFPA). Among the Pheo/PGL, 7 patients had a single tumour (4 Pheo and 3 PGL) and 3 patients had multiple or bilateral disease (2 PGL and 1 Pheo). Patients with GH-secreting PA and NFPA underwent surgery, while patients with prolactinoma received medical treatment (one patient required surgery). Unilateral adrenalectomy was carried out in all single Pheo and a bilateral procedure was performed in the patient with bilateral tumour. A single tumour was resected in two patients with multiple PGL. We found 3 germline pathogenic mutations: 2 in SDHB (c.166-170delCCTCA and a gross deletion involving exon 1) and 1 SDHD (p.P81L exon 3). Two variants of uncertain significance: 1 in MEN1 (c.1618C > T; p.Pro540Ser) and 1 in RET (c.2556C > G, p.Ile852Met), and finally a RETM918T somatic mutation in a Pheo tissue.ConclusionWe actively suggest considering the possibility of hereditary disease in all cases with 3PA and performing a complete genetic study.Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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