Objective : Silent corticotroph adenomas (SCA) are endocrine-inactive pituitary adenomas with positive immunohistochemistry staining for adrenocorticotropic hormone (ACTH). We investigated whether SCA-associated clinical profiles were more aggressive than hormonally negative adenomas (HNA). Methods : Among 627 patients with pathologically proven endocrine-inactive pituitary adenomas between 2004 and 2013, positive immunohistochemistry revealed 55 SCAs and 411 HNAs. Surgical outcomes and radiological and endocrinological characteristics were compared. Results : Strong female predominance was observed in the SCA group (p<0.001). Cavernous sinus invasion was identified in 22 (40%) SCA patients and 72 (17.6%) HNA patients (p<0.001). There were no differences in ACTH or cortisol levels between the two groups. The incidence of preoperative hypopituitarism and postoperative hormonal outcome did not differ between two groups. Total resection was achieved in 35 patients (63.7%) with SCA and 332 patients (80.8%) with HNA (p=0.007). When tumors were completely removed, recurrence rates were not statistically different between two groups (p=0.60). When complete resection was not achieved, tumors regrew from these remnants in seven patients (35.0%) with SCA and 12 patients (15.2%) with HNA (p=0.05). Conclusion : Total surgical resection for SCA is often challenging as these tumors frequently invade a cavernous sinus. Early remnant tumor intervention is justified, because untreated residual pituitary tumors regrow when patients were followed up for a long time. Prophylactic radiotherapy is not warranted for completely resected SCAs as tumor recurrence is uncommon.
Bibliographical noteFunding Information:
This study was supported by a faculty research grant of Yonsei University College of Medicine (6-2017-0040). The authors thank Juyoon Park, R.N., M.P.H., O.C.N., Min Kyeong Jang, R.N., Sung Ja Kang, R.N., and Bok Soon Lee, R.N., Sujin Ryu, R.N., Pituitary Tumor Center and Soo Yeon Choi, M.P.H., Department of Medical Recording for their tremendous effort in performing the endocrinological tests and data acquisition for such a long follow-up duration.
© 2019 The Korean Neurosurgical Society.
All Science Journal Classification (ASJC) codes
- Clinical Neurology