Clinical Parameters to Distinguish Silent Corticotroph Adenomas from Other Nonfunctioning Pituitary Adenomas.

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Clinical Parameters to Distinguish Silent Corticotroph Adenomas from Other Nonfunctioning Pituitary Adenomas.

World Neurosurg. 2018 Apr 17;:

Authors: Kim D, Ku CR, Park SH, Moon JH, Kim EH, Kim SH, Lee EJ

Abstract
BACKGROUND: It is difficult to distinguish silent corticotroph adenomas (SCAs) from other nonfunctioning pituitary adenomas (NFPAs) preoperatively. This study aimed to determine the preoperative clinical parameters associated with SCAs.
METHODS: This was a retrospective single-center study of patients who underwent surgery for NFPAs during 2011-2016 in our tertiary hospital and who had preoperative combined pituitary function test (CPFT) and immunohistochemical staining results available. After excluding patients with increased 24-hour urinary free cortisol to preclude overt Cushing's disease, 341 patients were finally enrolled. The medical records, including the CPFT and immunohistochemistry results, of the patients were reviewed.
RESULTS: The age and tumor size were similar between patients with SCAs and other NFPAs. The SCA group had a higher proportion of women (89.2% vs. 57.6%, P<0.001), cavernous sinus invasion (35.1% vs. 20.7%, P=0.047), and intratumoral hemorrhage on preoperative sella magnetic resonance imaging (32.4% vs. 9.2%, P<0.001) compared to the NFPA group. In the preoperative CPFT, the cortisol response was not significantly different between groups. However, the peak adrenocorticotropic hormone (ACTH) (67.80±49.83 vs. 85.67±78.97 pg/mL, P=0.061) tended to be lower, and the ΔACTH (53.71±50.14 vs. 72.67±75.82 pg/mL, P=0.046) was significantly lower in SCAs. After excluding patients with preoperative hypopituitarism caused by mass effects, the peak ACTH (69.39±39.45 vs. 119.75±89.84 pg/mL, P=0.001) and ΔACTH (58.58±36.51 vs. 107.66±86.05 pg/mL, P=0.001) were significantly lower in SCAs than in other NFPAs.
CONCLUSIONS: Female sex, cavernous sinus invasion, intratumoral hemorrhage on sella magnetic resonance imaging, and decreased ACTH response in the CPFT are independent indicators of SCAs.

PMID: 29678704 [PubMed - as supplied by publisher]

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