An asynchronous double growth hormone-secreting pituitary neoplasm (PitNET) of a different proliferative potential

Pituitary neuroendocrine tumors (PitNET) pose a real challenge and require multidisciplinary expert care as well as a patient-tailored diagnostic and therapeutic approach.Aggressive PitNETs are invasive, recur frequently, and often refract from standard therapies 1.Double adenomas, defined as two separate pituitary tumors co-existing, seem particularly demanding 2345.We present the case in which those two rare entities met.A 37-year-old man presented with left-sided painful gynecomastia.He denied symptoms of excessive GH secretion and did show minor acromegalic features.Due to low testosterone and LH concentrations with mild hyperprolactinemia, a pituitary MR was performed, which