The Clinical Usefulness of the PANOMEN 3 Grade Score
Pituitary adenomas, also referred to as pituitary neuroendocrine tumours, are, usually benign, neoplasms of the anterior pituitary gland. Pituitary adenomas can be categorized into subtypes based on secretory status, phenotype, size, invasion, histopathological characteristics, and proliferation index. These subtypes differ substantially in clinical presentation and natural course. Subsequently, treatment strategies vary between these subtypes. Until recently, classification systems all (partly) incorporated histopathology. As a result, pituitary adenomas not requiring surgery could not be classified by any of these classification systems. The second Pituitary Neoplasm Nomenclature workshop (PANOMEN 2), initiated by the Pituitary Society, addressed the need for a comprehensive classification system that could guide prognosis and therapy of all pituitary adenomas. The PANOMEN 3 clinical classification Workshop has proposed an all-inclusive classification system by integrating clinical, genetic, biochemical, radiological, pathological, and molecular data. Evidence-based risk factors that are associated with increased morbidity and mortality were included in the classification. A corrected score is calculated dependent on the amount of risk factors assessed and converted into a ranked grade of 0 to 3. These rank grades are hypothesized to be able to reflect disease severity together with a morbidity and mortality risk range. Until now, this classification system has not been applied to a cohort of patients with pituitary adenomas, also not during the stage of conceptualization. Therefore, the discriminative potential together with the clinical usefulness of the system is yet unknown.
Objective
The primary aim is to evaluate the clinical usefulness of the PANOMEN 3 Grade score in patients with all types of pituitary adenomas seen at Endo-ERN Reference Centers.
The secondary aim is to assess the unadjusted and adjusted predictive values of the individual risk factors included in the PANOMEN 3 Grade score on tumour specific and general (co)morbidity in patients with all types of pituitary adenoma seen at Endo-ERN Reference Centers.
Hypothesis
We hypothesize that the ranked PANOMEN Grade scores reflect a ranked association with (co)morbidities, where Grade score 3 results in the highest and Grade score 0 in the lowest prevalence of (co)morbidities.
Data collection
Longitudinal data will be collected at the following disease time points: at diagnosis, 2 years after diagnosis, 4 years after diagnosis, 5 years after diagnosis, 10 years after diagnosis, at the time of an intervention and 6 months after an intervention, and (in case of progression not followed by any intervention) at the moment of progression.
The presence of any of the predefined morbidities at the time of diagnosis is registered. During FU, study members are asked to register if an event has occurred, and if so, to specify the exact date of the event.
A final assessment of the patient’s status will be made on 1 October 2026 of those patients who are still in FU.
References
Members of this Study Group
Initiating team
| Name | Expertise / Role | Organisation |
|---|---|---|
| Lead: Alberto Pereira | endocrinologist, Endo-ERN Coordinator | Amsterdam University Medical Center |
| Dirk Jan Stenvers | endocrinologist | Amsterdam University Medical Center |
| Loren van der Hoeven | endocrinologist | Amsterdam University Medical Center |
| Emily White | Endo-ERN Project Manager & Operational Helpdesk Manager | Amsterdam University Medical Center |
Participating members
| Name | Organisation |
|---|---|
| Mai Christiansen Arlien-Søborg | Aarhus University Hospital |
| Filippo Ceccato | Azienda Ospedaliera di Padova (AOP) |
| Rosario Pivonello | Azienda Ospedaliera Universitaria “Federico II”, Napoli |
| Alfonso Soto Moreno | Complejo Hospitalario Regional Virgen del Rocío |
| Johan de Graaf | Endo-ERN, Dutch Pituitary Foundation |
| Georgia Ntali | Evangelismos Hospital, Athens |
| Giovanna Mantovani | Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico |
| Anna Aulinas Maso | Fundacio de Gestio Sanitaria Hospital de la Santa Creu i Sant Pau |
| Gerald Raverot | Hospices Civils de Lyon |
| Luis Antonio Castano | Hospital Universitario Cruces |
| Nuria Valdes | Hospital Universitario Cruces |
| Camilla Schalin-Jäntti | HUS Helsinki University Hospital, Hospital District of Helsinki and Uusimaa (EndoERN_FIN) |
| Federico Gatto | IRCCS Ospedale Policlinico San Martino |
| Nienke Biermasz | Leiden University Medical Center |
| Natasha Appelman-Dijkstra | Leiden University Medical Center (EuRREB) |
| Mariya Cherenko | Leiden University Medical Center (EuRREB) |
| Katharina Schilbach | Ludwig-Maximilian-University Munich |
| Savi Shishkov | MHAT “Sveta Marina” |
| Tobias Hallén | Sahlgrenska University Hospital |
| Carmen Georgescu | Spitalul Clinic Judetean de Urgenta Cluj (Cluj County Emergency Clinical Hospital) |
| Corina Andreescu | UZ Brussels |
| Caroline Kistorp | Rigshospitalet |
| Benedetta Fibbi | University Hospital Florence |
The Clinical Usefulness of the PANOMEN 3 Grade Score
Pituitary adenomas, also referred to as pituitary neuroendocrine tumours, are, usually benign, neoplasms of the anterior pituitary gland. Pituitary adenomas can be categorized into subtypes based on secretory status, phenotype, size, invasion, histopathological characteristics, and proliferation index. These subtypes differ substantially in clinical presentation and natural course. Subsequently, treatment strategies vary between these subtypes. Until recently, classification systems all (partly) incorporated histopathology. As a result, pituitary adenomas not requiring surgery could not be classified by any of these classification systems. The second Pituitary Neoplasm Nomenclature workshop (PANOMEN 2), initiated by the Pituitary Society, addressed the need for a comprehensive classification system that could guide prognosis and therapy of all pituitary adenomas. The PANOMEN 3 clinical classification Workshop has proposed an all-inclusive classification system by integrating clinical, genetic, biochemical, radiological, pathological, and molecular data. Evidence-based risk factors that are associated with increased morbidity and mortality were included in the classification. A corrected score is calculated dependent on the amount of risk factors assessed and converted into a ranked grade of 0 to 3. These rank grades are hypothesized to be able to reflect disease severity together with a morbidity and mortality risk range. Until now, this classification system has not been applied to a cohort of patients with pituitary adenomas, also not during the stage of conceptualization. Therefore, the discriminative potential together with the clinical usefulness of the system is yet unknown.
Objective
The primary aim is to evaluate the clinical usefulness of the PANOMEN 3 Grade score in patients with all types of pituitary adenomas seen at Endo-ERN Reference Centers.
The secondary aim is to assess the unadjusted and adjusted predictive values of the individual risk factors included in the PANOMEN 3 Grade score on tumour specific and general (co)morbidity in patients with all types of pituitary adenoma seen at Endo-ERN Reference Centers.
Hypothesis
We hypothesize that the ranked PANOMEN Grade scores reflect a ranked association with (co)morbidities, where Grade score 3 results in the highest and Grade score 0 in the lowest prevalence of (co)morbidities.
Data collection
Longitudinal data will be collected at the following disease time points: at diagnosis, 2 years after diagnosis, 4 years after diagnosis, 5 years after diagnosis, 10 years after diagnosis, at the time of an intervention and 6 months after an intervention, and (in case of progression not followed by any intervention) at the moment of progression.
The presence of any of the predefined morbidities at the time of diagnosis is registered. During FU, study members are asked to register if an event has occurred, and if so, to specify the exact date of the event.
A final assessment of the patient’s status will be made on 1 October 2026 of those patients who are still in FU.
References
Members of this Study Group
Initiating team
| Name | Expertise / Role | Organisation |
|---|---|---|
| Lead: Alberto Pereira | endocrinologist, Endo-ERN Coordinator | Amsterdam University Medical Center |
| Dirk Jan Stenvers | endocrinologist | Amsterdam University Medical Center |
| Loren van der Hoeven | endocrinologist | Amsterdam University Medical Center |
| Emily White | Endo-ERN Project Manager & Operational Helpdesk Manager | Amsterdam University Medical Center |
Participating members
| Name | Organisation |
|---|---|
| Mai Christiansen Arlien-Søborg | Aarhus University Hospital |
| Filippo Ceccato | Azienda Ospedaliera di Padova (AOP) |
| Rosario Pivonello | Azienda Ospedaliera Universitaria “Federico II”, Napoli |
| Alfonso Soto Moreno | Complejo Hospitalario Regional Virgen del Rocío |
| Johan de Graaf | Endo-ERN, Dutch Pituitary Foundation |
| Georgia Ntali | Evangelismos Hospital, Athens |
| Giovanna Mantovani | Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico |
| Anna Aulinas Maso | Fundacio de Gestio Sanitaria Hospital de la Santa Creu i Sant Pau |
| Gerald Raverot | Hospices Civils de Lyon |
| Luis Antonio Castano | Hospital Universitario Cruces |
| Nuria Valdes | Hospital Universitario Cruces |
| Camilla Schalin-Jäntti | HUS Helsinki University Hospital, Hospital District of Helsinki and Uusimaa (EndoERN_FIN) |
| Federico Gatto | IRCCS Ospedale Policlinico San Martino |
| Nienke Biermasz | Leiden University Medical Center |
| Natasha Appelman-Dijkstra | Leiden University Medical Center (EuRREB) |
| Mariya Cherenko | Leiden University Medical Center (EuRREB) |
| Katharina Schilbach | Ludwig-Maximilian-University Munich |
| Savi Shishkov | MHAT “Sveta Marina” |
| Tobias Hallén | Sahlgrenska University Hospital |
| Carmen Georgescu | Spitalul Clinic Judetean de Urgenta Cluj (Cluj County Emergency Clinical Hospital) |
| Corina Andreescu | UZ Brussels |
| Caroline Kistorp | Rigshospitalet |
| Benedetta Fibbi | University Hospital Florence |