ATRX and neoplasm: Germline genetic testing is recommended in APTs, particularly when patients are young or have a family history of pituitary or endocrine neoplasia.25 Although APTs and CPs are more frequent in patients carrying germline mutations, these have not to date been associated with aggressive behavior.5,6,26Somatic mutations in genes such as ATRX and TP53 have shown promise in predicting tumor behavior.