Pituitary neuroendocrine tumors (PitNETs) are classified based on cell lineage, determined by immunohistochemistry for adenohypophyseal hormones and transcription factors (TFs) such as PIT1, SF1, and TPIT. According to the 2022 WHO classification, PitNETs with co-expression of multiple TFs are termed "plurihormonal." This study investigated the clinicopathological and molecular features of PitNETs with co-expression of PIT1 and SF1, which are typically associated with the somatotroph lineage. Among 100 somatotroph PitNETs, 74% (52/70) of densely granulated somatotroph PitNETs (DGST) co-expressed PIT1 and SF1 (DGST-PIT1/SF1), while none of the sparsely granulated somatotroph PitNETs (SGST) expressed SF1. DGST-PIT1/SF1 tumors showed distinct histopathological and molecular features compared to DGST-PIT1 and SGST-PIT1. Molecular analyses confirmed that DGST-PIT1/SF1, DGST-PIT1, and SGST-PIT1 represent distinct tumor subtypes. Clinicopathological meta-analyses indicated that DGST-PIT1 responds more favorably to treatment with somatostatin analogs compared to DGST-PIT1/SF1, while both subtypes show a less aggressive clinical course than SGST-PIT1. The study highlights that DGST with co-expression of PIT1 and SF1 represent a common, yet underrecognized, distinct PitNET subtype. The findings challenge the current WHO classification, which classifies such tumors as "plurihormonal," and suggest a need for refinement. The authors propose the term "somatogonadotroph PitNET" for DGST-PIT1/SF1. This study provides a comprehensive meta-analysis of the three emerging molecular subtypes of somatotroph PitNETs, calling for a refinement of the current WHO 2022 classification.Pituitary neuroendocrine tumors (PitNETs) are classified based on cell lineage, determined by immunohistochemistry for adenohypophyseal hormones and transcription factors (TFs) such as PIT1, SF1, and TPIT. According to the 2022 WHO classification, PitNETs with co-expression of multiple TFs are termed "plurihormonal." This study investigated the clinicopathological and molecular features of PitNETs with co-expression of PIT1 and SF1, which are typically associated with the somatotroph lineage. Among 100 somatotroph PitNETs, 74% (52/70) of densely granulated somatotroph PitNETs (DGST) co-expressed PIT1 and SF1 (DGST-PIT1/SF1), while none of the sparsely granulated somatotroph PitNETs (SGST) expressed SF1. DGST-PIT1/SF1 tumors showed distinct histopathological and molecular features compared to DGST-PIT1 and SGST-PIT1. Molecular analyses confirmed that DGST-PIT1/SF1, DGST-PIT1, and SGST-PIT1 represent distinct tumor subtypes. Clinicopathological meta-analyses indicated that DGST-PIT1 responds more favorably to treatment with somatostatin analogs compared to DGST-PIT1/SF1, while both subtypes show a less aggressive clinical course than SGST-PIT1. The study highlights that DGST with co-expression of PIT1 and SF1 represent a common, yet underrecognized, distinct PitNET subtype. The findings challenge the current WHO classification, which classifies such tumors as "plurihormonal," and suggest a need for refinement. The authors propose the term "somatogonadotroph PitNET" for DGST-PIT1/SF1. This study provides a comprehensive meta-analysis of the three emerging molecular subtypes of somatotroph PitNETs, calling for a refinement of the current WHO 2022 classification.