Browsing by Author "Burman, Pia (7004519451)"

The European Society of Endocrinology (ESE) survey reported on the largest cohort of 125 aggressive pituitary tumours (APT) and 40 pituitary carcinomas (PC). Whilst the survey focused on treatment effectiveness, all pathological data were not explored in detail. Here, we comment on some interesting pathological findings, notably the difference between APT and PC. © 2018 European Society of Endocrinology Printed in Great Britain.

The European Society of Endocrinology (ESE) survey reported on the largest cohort of 125 aggressive pituitary tumours (APT) and 40 pituitary carcinomas (PC). Whilst the survey focused on treatment effectiveness, all pathological data were not explored in detail. Here, we comment on some interesting pathological findings, notably the difference between APT and PC. © 2018 European Society of Endocrinology Printed in Great Britain.

Pituitary adenohypophyseal tumors are considered as benign and termed “adenomas”. However, many tumors are invasive and a proportion of these exhibit an “aggressive behavior” with premature death due to progressive growth. Only very rare (0.2%) tumors with metastases are considered malignant and termed “carcinomas”. Taking into account this variability in behavior and the oncological definition, pathologists have proposed changing the term adenoma to tumor. Here we explain why use the term tumor instead of adenoma and identify tumor characteristics, associated with a high risk for poor prognosis. In a cohort of 125 tumors with aggressive behavior (APT) and 40 carcinomas with metastases (PC), clinical and pathological features were very similar. The comparison of this cohort (APT+PC) with a reference surgical cohort of 374 unselected patients clearly shows that the two cohorts differ greatly, especially the percentage of tumors with Ki67 ≥ 10% (35%vs3%; p < 0.001). A five-tiered prognostic classification, associating invasion and proliferation, identified grade 2b tumors (invasive and proliferative), with a high risk of recurrence/progression. Because half of the APT+ PC tumors have a Ki67 index ≥10%, and 80% of them show 2 or 3 positive markers of proliferation, we suggest that tumors that are clinically aggressive, invasive and highly proliferative with a Ki67 ≥ 10%, represent tumors with malignant potential. The percentage of grade 2b tumors, suspected of malignancy, which will become aggressive tumors or carcinomas is unknown. It is probably very low, but higher than 0.2% in surgical series. Early identification and active treatment of these aggressive tumors is needed to decrease morbidity and prolong survival. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

Pituitary adenohypophyseal tumors are considered as benign and termed “adenomas”. However, many tumors are invasive and a proportion of these exhibit an “aggressive behavior” with premature death due to progressive growth. Only very rare (0.2%) tumors with metastases are considered malignant and termed “carcinomas”. Taking into account this variability in behavior and the oncological definition, pathologists have proposed changing the term adenoma to tumor. Here we explain why use the term tumor instead of adenoma and identify tumor characteristics, associated with a high risk for poor prognosis. In a cohort of 125 tumors with aggressive behavior (APT) and 40 carcinomas with metastases (PC), clinical and pathological features were very similar. The comparison of this cohort (APT+PC) with a reference surgical cohort of 374 unselected patients clearly shows that the two cohorts differ greatly, especially the percentage of tumors with Ki67 ≥ 10% (35%vs3%; p < 0.001). A five-tiered prognostic classification, associating invasion and proliferation, identified grade 2b tumors (invasive and proliferative), with a high risk of recurrence/progression. Because half of the APT+ PC tumors have a Ki67 index ≥10%, and 80% of them show 2 or 3 positive markers of proliferation, we suggest that tumors that are clinically aggressive, invasive and highly proliferative with a Ki67 ≥ 10%, represent tumors with malignant potential. The percentage of grade 2b tumors, suspected of malignancy, which will become aggressive tumors or carcinomas is unknown. It is probably very low, but higher than 0.2% in surgical series. Early identification and active treatment of these aggressive tumors is needed to decrease morbidity and prolong survival. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

Objective: Germline mutations in the MEN1 gene predispose to the multiple endocrine neoplasia (MEN1) syndrome; however, approximately 10-20% of patients with MEN1 do not have a detectable MEN1 mutation. A rat strain with multiple endocrine tumours, a phenotypic overlap of both MEN1 and MEN2, has been reported to have a homozygous germline p27 (CDKN1B) mutation. Recently, two MEN1 mutation-negative MEN1 syndrome patients have been identified to harbour a germline CDKN1B mutation. The recently identified gene AIP can also cause familial isolated pituitary adenoma, but no other specific tumour is associated with this syndrome. The objective of this study was to evaluate the possible contribution of CDKN1B and AIP germline mutations in a cohort of MEN1 mutation-negative MEN1 syndrome patients. Patients: Eighteen sporadic and three familial cases of MEN1 mutation-negative MEN1 syndrome were studied (18 pituitary adenomas, 12 hyperparathyroidism, 10 neuroendocrine tumours including 2 ACTH-secreting lesions and one adrenal nodular hyperplasia). Clinical data and genomic DNA were analysed for mutations in the CDKN1B and AIP genes. Results: There were no mutations in the coding region or exon/intron junction of the CDKN1B and AIP genes in any patient. Although we have a limited number of patients in our cohort, our data is consistent with others in the literature suggesting that CDKN1B and AIP mutations are extremely rare in MEN1 syndrome. Conclusion: Our results suggest that mutations in the CDKN1B and AIP genes are relatively uncommon in MEN1 mutation-negative MEN1 syndrome patients. © 2009 The Authors.

Objective: Germline mutations in the MEN1 gene predispose to the multiple endocrine neoplasia (MEN1) syndrome; however, approximately 10-20% of patients with MEN1 do not have a detectable MEN1 mutation. A rat strain with multiple endocrine tumours, a phenotypic overlap of both MEN1 and MEN2, has been reported to have a homozygous germline p27 (CDKN1B) mutation. Recently, two MEN1 mutation-negative MEN1 syndrome patients have been identified to harbour a germline CDKN1B mutation. The recently identified gene AIP can also cause familial isolated pituitary adenoma, but no other specific tumour is associated with this syndrome. The objective of this study was to evaluate the possible contribution of CDKN1B and AIP germline mutations in a cohort of MEN1 mutation-negative MEN1 syndrome patients. Patients: Eighteen sporadic and three familial cases of MEN1 mutation-negative MEN1 syndrome were studied (18 pituitary adenomas, 12 hyperparathyroidism, 10 neuroendocrine tumours including 2 ACTH-secreting lesions and one adrenal nodular hyperplasia). Clinical data and genomic DNA were analysed for mutations in the CDKN1B and AIP genes. Results: There were no mutations in the coding region or exon/intron junction of the CDKN1B and AIP genes in any patient. Although we have a limited number of patients in our cohort, our data is consistent with others in the literature suggesting that CDKN1B and AIP mutations are extremely rare in MEN1 syndrome. Conclusion: Our results suggest that mutations in the CDKN1B and AIP genes are relatively uncommon in MEN1 mutation-negative MEN1 syndrome patients. © 2009 The Authors.

In the original publication of this article, upper and lower part of Table 2 was incorrectly formatted. The incorrect and correct version of Table 2 are shown in this correction article. The original article has been corrected. Relevant significantly enriched gene sets associated with the DMPs that differed between aggressive and metastatic PitNETs in the first surgery specimens (upper table) and in the entire cohort (lower table) Hypermethylated and positive enriched in PC pval padj NES size KEGG cell adhesion molecules CAMS 6.26E-07 5.63E-05 1.65 122 KEGG axon guidance 6.51E-07 5.63E-05 1.65 122 KEGG pathways in cancer 1.43E-06 8.24E-05 1.44 313 KEGG neuroactive ligand receptor interaction 6.39E-06 0.00028 1.44 249 KEGG focal adhesion 7.16E-05 0.0015 1.44 191 KEGG adherens junction 8.97E-05 0.0017 1.64 67 KEGG calcium signaling pathway 0.00025 0.0039 1.40 166 KEGG leukocyte transendothelial migration 0.0019 0.019 1.43 108 KEGG ECM receptor interaction 0.0019 0.019 1.49 83 KEGG gap junction 0.0063 0.036 1.40 83 KEGG axon guidance 1.60E-06 0.00028 1.53 122 KEGG calcium signaling pathway 3.22E-06 0.00028 1.44 166 KEGG neuroactive ligand receptor interaction 0.00010 0.0045 1.31 249 KEGG regulation of actin cytoskeleton 0.00013 0.0045 1.34 197 KEGG MAPK signaling pathway 0.00030 0.0066 1.29 251 KEGG cell adhesion molecules cams 0.0018 0.035 1.33 122 KEGG ECM receptor interaction 0.0034 0.049 1.36 83 KEGG Wnt signaling pathway 0.0052 0.064 1.27 145 KEGG Hedgehog signaling pathway 0.0057 0.064 1.40 55 KEGG leukocyte transendothelial migration 0.011 0.10 1.28 108 Relevant significantly enriched gene sets associated with the DMPs that differed between aggressive and metastatic PitNETs in the first surgery specimens (upper part of the table) and in the entire cohort (lower part of the table) Hypermethylated and positive enriched in PC pval padj NES size KEGG Cell adhesion molecules CAMS 6.26E-07 5.63E-05 1.65 122 KEGG Axon guidance 6.51E-07 5.63E-05 1.65 122 KEGG Pathways in cancer 1.43E-06 8.24E-05 1.44 313 KEGG Neuroactive ligand receptor interaction 6.39E-06 0.00028 1.44 249 KEGG Focal adhesion 7.16E-05 0.0015 1.44 191 KEGG Adherens junction 8.97E-05 0.0017 1.64 67 KEGG Calcium signaling pathway 0.00025 0.0039 1.40 166 KEGG Leukocyte transendothelial migration 0.0019 0.019 1.43 108 KEGG ECM receptor interaction 0.0019 0.019 1.49 83 KEGG Gap junction 0.0063 0.036 1.40 83 Hypermethylated and positive enriched in PC pval padj NES size KEGG Axon guidance 1.60E-06 0.00028 1.53 122 KEGG Calcium signaling pathway 3.22E-06 0.00028 1.44 166 KEGG Neuroactive ligand receptor interaction 0.00010 0.0045 1.31 249 KEGG Regulation of actin cytoskeleton 0.00013 0.0045 1.34 197 KEGG MAPK signaling pathway 0.00030 0.0066 1.29 251 KEGG Cell adhesion molecules cams 0.0018 0.035 1.33 122 KEGG ECM receptor interaction 0.0034 0.049 1.36 83 KEGG Wnt signaling pathway 0.0052 0.064 1.27 145 KEGG Hedgehog signaling pathway 0.0057 0.064 1.40 55 KEGG Leukocyte transendothelial migration 0.011 0.10 1.28 108 © The Author(s) 2024.

In the original publication of this article, upper and lower part of Table 2 was incorrectly formatted. The incorrect and correct version of Table 2 are shown in this correction article. The original article has been corrected. Relevant significantly enriched gene sets associated with the DMPs that differed between aggressive and metastatic PitNETs in the first surgery specimens (upper table) and in the entire cohort (lower table) Hypermethylated and positive enriched in PC pval padj NES size KEGG cell adhesion molecules CAMS 6.26E-07 5.63E-05 1.65 122 KEGG axon guidance 6.51E-07 5.63E-05 1.65 122 KEGG pathways in cancer 1.43E-06 8.24E-05 1.44 313 KEGG neuroactive ligand receptor interaction 6.39E-06 0.00028 1.44 249 KEGG focal adhesion 7.16E-05 0.0015 1.44 191 KEGG adherens junction 8.97E-05 0.0017 1.64 67 KEGG calcium signaling pathway 0.00025 0.0039 1.40 166 KEGG leukocyte transendothelial migration 0.0019 0.019 1.43 108 KEGG ECM receptor interaction 0.0019 0.019 1.49 83 KEGG gap junction 0.0063 0.036 1.40 83 KEGG axon guidance 1.60E-06 0.00028 1.53 122 KEGG calcium signaling pathway 3.22E-06 0.00028 1.44 166 KEGG neuroactive ligand receptor interaction 0.00010 0.0045 1.31 249 KEGG regulation of actin cytoskeleton 0.00013 0.0045 1.34 197 KEGG MAPK signaling pathway 0.00030 0.0066 1.29 251 KEGG cell adhesion molecules cams 0.0018 0.035 1.33 122 KEGG ECM receptor interaction 0.0034 0.049 1.36 83 KEGG Wnt signaling pathway 0.0052 0.064 1.27 145 KEGG Hedgehog signaling pathway 0.0057 0.064 1.40 55 KEGG leukocyte transendothelial migration 0.011 0.10 1.28 108 Relevant significantly enriched gene sets associated with the DMPs that differed between aggressive and metastatic PitNETs in the first surgery specimens (upper part of the table) and in the entire cohort (lower part of the table) Hypermethylated and positive enriched in PC pval padj NES size KEGG Cell adhesion molecules CAMS 6.26E-07 5.63E-05 1.65 122 KEGG Axon guidance 6.51E-07 5.63E-05 1.65 122 KEGG Pathways in cancer 1.43E-06 8.24E-05 1.44 313 KEGG Neuroactive ligand receptor interaction 6.39E-06 0.00028 1.44 249 KEGG Focal adhesion 7.16E-05 0.0015 1.44 191 KEGG Adherens junction 8.97E-05 0.0017 1.64 67 KEGG Calcium signaling pathway 0.00025 0.0039 1.40 166 KEGG Leukocyte transendothelial migration 0.0019 0.019 1.43 108 KEGG ECM receptor interaction 0.0019 0.019 1.49 83 KEGG Gap junction 0.0063 0.036 1.40 83 Hypermethylated and positive enriched in PC pval padj NES size KEGG Axon guidance 1.60E-06 0.00028 1.53 122 KEGG Calcium signaling pathway 3.22E-06 0.00028 1.44 166 KEGG Neuroactive ligand receptor interaction 0.00010 0.0045 1.31 249 KEGG Regulation of actin cytoskeleton 0.00013 0.0045 1.34 197 KEGG MAPK signaling pathway 0.00030 0.0066 1.29 251 KEGG Cell adhesion molecules cams 0.0018 0.035 1.33 122 KEGG ECM receptor interaction 0.0034 0.049 1.36 83 KEGG Wnt signaling pathway 0.0052 0.064 1.27 145 KEGG Hedgehog signaling pathway 0.0057 0.064 1.40 55 KEGG Leukocyte transendothelial migration 0.011 0.10 1.28 108 © The Author(s) 2024.

Context: Aggressive pituitary tumors (APTs) are characterized by unusually rapid growth and lack of response to standard treatment. About 1% to 2% develop metastases being classified as pituitary carcinomas (PCs). For unknown reasons, the corticotroph tumors are overrepresented among APTs and PCs. Mutations in the alpha thalassemia/mental retardation syndrome X-linked (ATRX) gene, regulating chromatin remodeling and telomere maintenance, have been implicated in the development of several cancer types, including neuroendocrine tumors. Objective: To study ATRX protein expression and mutational status of the ATRX gene in APTs and PCs. Design: We investigated ATRX protein expression by using immunohistochemistry in 30 APTs and 18 PCs, mostly of Pit-1 and T-Pit cell lineage. In tumors lacking ATRX immunolabeling, mutational status of the ATRX gene was explored. Results: Nine of the 48 tumors (19%) demonstrated lack of ATRX immunolabelling with a higher proportion in patients with PCs (5/18; 28%) than in those with APTs (4/30;13%). Lack of ATRX was most common in the corticotroph tumors, 7/22 (32%), versus tumors of the Pit-1 lineage, 2/24 (8%). Loss-of-function ATRX mutations were found in all 9 ATRX immunonegative cases: nonsense mutations (n = 4), frameshift deletions (n = 4), and large deletions affecting 22-28 of the 36 exons (n = 3). More than 1 ATRX gene defect was identified in 2 PCs. Conclusion: ATRX mutations occur in a subset of APTs and are more common in corticotroph tumors. The findings provide a rationale for performing ATRX immunohistochemistry to identify patients at risk of developing aggressive and potentially metastatic pituitary tumors. © 2020 The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society.

Context: Aggressive pituitary tumors (APTs) are characterized by unusually rapid growth and lack of response to standard treatment. About 1% to 2% develop metastases being classified as pituitary carcinomas (PCs). For unknown reasons, the corticotroph tumors are overrepresented among APTs and PCs. Mutations in the alpha thalassemia/mental retardation syndrome X-linked (ATRX) gene, regulating chromatin remodeling and telomere maintenance, have been implicated in the development of several cancer types, including neuroendocrine tumors. Objective: To study ATRX protein expression and mutational status of the ATRX gene in APTs and PCs. Design: We investigated ATRX protein expression by using immunohistochemistry in 30 APTs and 18 PCs, mostly of Pit-1 and T-Pit cell lineage. In tumors lacking ATRX immunolabeling, mutational status of the ATRX gene was explored. Results: Nine of the 48 tumors (19%) demonstrated lack of ATRX immunolabelling with a higher proportion in patients with PCs (5/18; 28%) than in those with APTs (4/30;13%). Lack of ATRX was most common in the corticotroph tumors, 7/22 (32%), versus tumors of the Pit-1 lineage, 2/24 (8%). Loss-of-function ATRX mutations were found in all 9 ATRX immunonegative cases: nonsense mutations (n = 4), frameshift deletions (n = 4), and large deletions affecting 22-28 of the 36 exons (n = 3). More than 1 ATRX gene defect was identified in 2 PCs. Conclusion: ATRX mutations occur in a subset of APTs and are more common in corticotroph tumors. The findings provide a rationale for performing ATRX immunohistochemistry to identify patients at risk of developing aggressive and potentially metastatic pituitary tumors. © 2020 The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society.

Background: Pituitary tumours are common and easily treated by surgery or medical treatment in most cases. However, a small subset of pituitary tumours does not respond to standard medical treatment and presents with multiple local recurrences (aggressive pituitary tumours) and in rare occasion with metastases (pituitary carcinoma). The present European Society of Endocrinology (ESE) guideline aims to provide clinical guidance on diagnosis, treatment and follow-up in aggressive pituitary tumours and carcinomas. Methods: We decided upfront, while acknowledging that literature on aggressive pituitary tumours and carcinomas is scarce, to systematically review the literature according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The review focused primarily on frst-and second-line treatment in aggressive pituitary tumours and carcinomas. We included 14 single-arm cohort studies (total number of patients = 116) most on temozolomide treatment (n = 11 studies, total number of patients = 106). A positive treatment effect was seen in 47% (95% CI: 36-58%) of temozolomide treated. Data from the recently performed ESE survey on aggressive pituitary tumours and carcinomas (165 patients) were also used as backbone for the guideline. Selected recommendation: (i) Patients with aggressive pituitary tumours should be managed by a multidisciplinary expert team. (ii) Histopathological analyses including pituitary hormones and proliferative markers are needed for correct tumour classifcation. (iii) Temozolomide monotherapy is the frst-line chemotherapy for aggressive pituitary tumours and pituitary carcinomas after failure of standard therapies; treatment evaluation after 3 cycles allows identifcation of responder and non-responder patients. (iv) In patients responding to frst-line temozolomide, we suggest continuing treatment for at least 6 months in total. Furthermore, the guideline offers recommendations for patients who recurred after temozolomide treatment, for those who did not respond to temozolomide and for patients with systemic metastasis. © 2018 European Society of Endocrinology.

Background: Pituitary tumours are common and easily treated by surgery or medical treatment in most cases. However, a small subset of pituitary tumours does not respond to standard medical treatment and presents with multiple local recurrences (aggressive pituitary tumours) and in rare occasion with metastases (pituitary carcinoma). The present European Society of Endocrinology (ESE) guideline aims to provide clinical guidance on diagnosis, treatment and follow-up in aggressive pituitary tumours and carcinomas. Methods: We decided upfront, while acknowledging that literature on aggressive pituitary tumours and carcinomas is scarce, to systematically review the literature according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The review focused primarily on frst-and second-line treatment in aggressive pituitary tumours and carcinomas. We included 14 single-arm cohort studies (total number of patients = 116) most on temozolomide treatment (n = 11 studies, total number of patients = 106). A positive treatment effect was seen in 47% (95% CI: 36-58%) of temozolomide treated. Data from the recently performed ESE survey on aggressive pituitary tumours and carcinomas (165 patients) were also used as backbone for the guideline. Selected recommendation: (i) Patients with aggressive pituitary tumours should be managed by a multidisciplinary expert team. (ii) Histopathological analyses including pituitary hormones and proliferative markers are needed for correct tumour classifcation. (iii) Temozolomide monotherapy is the frst-line chemotherapy for aggressive pituitary tumours and pituitary carcinomas after failure of standard therapies; treatment evaluation after 3 cycles allows identifcation of responder and non-responder patients. (iv) In patients responding to frst-line temozolomide, we suggest continuing treatment for at least 6 months in total. Furthermore, the guideline offers recommendations for patients who recurred after temozolomide treatment, for those who did not respond to temozolomide and for patients with systemic metastasis. © 2018 European Society of Endocrinology.

Aggressive pituitary neuroendocrine tumors (PitNETs)/adenomas are characterized by progressive growth despite surgery and all standard medical therapies and radiotherapy. A subset will metastasize to the brain and/or distant locations and are termed metastatic PitNETs (pituitary carcinomas). Studies of potential prognostic markers have been limited due to the rarity of these tumors. A few recurrent somatic mutations have been identified, and epigenetic alterations and chromosomal rearrangements have not been explored in larger cohorts of aggressive and metastatic PitNETs. In this study, we performed genome-wide methylation analysis, including copy-number variation (CNV) calculations, on tumor tissue specimens from a large international cohort of 64 patients with aggressive (48) and metastatic (16) pituitary tumors. Twelve patients with non-invasive pituitary tumors (Knosp 0–2) exhibiting an indolent course over a 5 year follow-up served as controls. In an unsupervised hierarchical cluster analysis, aggressive/metastatic PitNETs clustered separately from benign pituitary tumors, and, when only specimens from the first surgery were analyzed, three separate clusters were identified: aggressive, metastatic, and benign PitNETs. Numerous CNV events affecting chromosomal arms and whole chromosomes were frequent in aggressive and metastatic, whereas benign tumors had normal chromosomal copy numbers with only few alterations. Genome-wide methylation analysis revealed different CNV profiles and a clear separation between aggressive/metastatic and benign pituitary tumors, potentially providing biomarkers for identification of these tumors with a worse prognosis at the time of first surgery. The data may refine follow-up routines and contribute to the timely introduction of adjuvant therapy in patients harboring, or at risk of developing, aggressive or metastatic pituitary tumors. © The Author(s) 2024.

Aggressive pituitary neuroendocrine tumors (PitNETs)/adenomas are characterized by progressive growth despite surgery and all standard medical therapies and radiotherapy. A subset will metastasize to the brain and/or distant locations and are termed metastatic PitNETs (pituitary carcinomas). Studies of potential prognostic markers have been limited due to the rarity of these tumors. A few recurrent somatic mutations have been identified, and epigenetic alterations and chromosomal rearrangements have not been explored in larger cohorts of aggressive and metastatic PitNETs. In this study, we performed genome-wide methylation analysis, including copy-number variation (CNV) calculations, on tumor tissue specimens from a large international cohort of 64 patients with aggressive (48) and metastatic (16) pituitary tumors. Twelve patients with non-invasive pituitary tumors (Knosp 0–2) exhibiting an indolent course over a 5 year follow-up served as controls. In an unsupervised hierarchical cluster analysis, aggressive/metastatic PitNETs clustered separately from benign pituitary tumors, and, when only specimens from the first surgery were analyzed, three separate clusters were identified: aggressive, metastatic, and benign PitNETs. Numerous CNV events affecting chromosomal arms and whole chromosomes were frequent in aggressive and metastatic, whereas benign tumors had normal chromosomal copy numbers with only few alterations. Genome-wide methylation analysis revealed different CNV profiles and a clear separation between aggressive/metastatic and benign pituitary tumors, potentially providing biomarkers for identification of these tumors with a worse prognosis at the time of first surgery. The data may refine follow-up routines and contribute to the timely introduction of adjuvant therapy in patients harboring, or at risk of developing, aggressive or metastatic pituitary tumors. © The Author(s) 2024.

[No abstract available]

[No abstract available]

Pituitary tumours, originating from endocrine cells of the anterior pituitary, are quite common, and in most cases well-controlled by surgery or medical treatment. However, a small subset of pituitary tumours presents with multiple local recurrences or tumour progression despite combined surgical, medical or radiotherapeutic treatment. These are known as aggressive pituitary tumours (APT); also called aggressive pituitary neuroendocrine tumours (PitNETs); or, in the rare case of metastases, pituitary carcinomas (PC) or metastatic PitNETs. Early identification of APT is challenging but is of major clinical importance as they are associated with an increased morbidity and mortality even in the absence of metastases. Here, we provide a revision of the first international, interdisciplinary European Society of Endocrinology (ESE) clinical practice guideline on APTs and PC (2018). Since publication of the 2018 guideline, results from the second ESE survey on APT and PC were published, and more data on APT treatment, including temozolomide, immune checkpoint inhibitors and bevacizumab, emerged. These data are reviewed in this guideline and translated into a practical algorithm to guide APT and PC management. Furthermore, standardized reporting of imaging and histopathological investigations of these tumours is proposed, and the role of molecular analysis is discussed. Last, a section is dedicated to special circumstances such as APT in pregnancy. © 2025 The Author(s). Published by Oxford University Press on behalf of European Society of Endocrinology.