A novel hypothesis on cystic changes in pituitary adenomas and their association with a distinct local blood supply pattern

Pituitary adenoma, a common neuroendocrine tumor, commonly exhibits cystic changes as a distinct feature. Here we introduce and investigate a novel hypothesis suggesting a potential correlation between cystic pituitary adenomas and the unique local blood supply patterns of pituitary adenomas. As the tumor expands, compression of the superior vessels results in reduced blood supply from the superior hypophyseal artery, resulting in uneven distribution of the blood flow. Detailed analysis of clinical and surgical features of pituitary macroadenomas showed that cystic changes predominantly manifest in the upper part of the tumor and are driven by metabolic activity and relatively insufficient blood supply in this region. Supporting evidence from dynamic contrast-enhanced magnetic resonance imaging studies further substantiated this hypothesis. Overall, our findings offer a fresh perspective for early diagnosis and surgical decision-making for pituitary adenomas, contributing valuable information for individualized treatment and an improved prognosis. Despite some potential limitations, this hypothesis provides crucial insights into the understanding and management of pituitary adenomas.