Skip to main content

Advertisement

SpringerLink
Log in

Clinical features of silent corticotroph adenomas

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Silent corticotrph adenomas represent a distinct pathological subtype of non-functioning pituitary adenomas that are traditionally believed to carry a more aggressive biological behavior and higher potential for recurrence.

Methods

We conducted a retrospective review of all silent corticotroph adenomas treated and followed at our institution over the last 10 years. We reviewed clinical, radiological and pathological features. The series was compared to a matched cohort of ACTH-negative, non-functioning adenomas to compare clinical, radiological and pathological features. Our results were compared to the literature.

Results

Twenty patients met our inclusion criteria. Fifty-six percent of the patients were females. Mean age was 51 years (range 24–78 years). Visual dysfunction was the most common clinical presentation (38 %). Thirteen percent of the cases presented with acromegaly secondary to double adenoma (silent corticotroph adenoma and growth hormone adenoma) and 13 % presented with pituitary tumor apoplexy. All the tumors were macroadenomas. Frank cavernous sinus invasion occurred in 31 % of the cases. The patients who presented with acromegaly did not achieve remission postoperatively. In the remaining patients, recurrence occurred in 14 % of the cases over a mean follow-up period of 41 months. Compared to non-functioning adenomas, silent corticotroph adenomas were more likely to bleed (p value 0.014) and have double adenoma (p value 0.047). There was no difference in recurrence rates between silent corticotroph adenomas and non-functioning adenomas (p value 0.647).

Conclusion

These results suggest that silent corticotroph adenomas have some unique features compared to non-functioning adenomas. Within the limits of our follow-up duration and sample size and our review of the literature, we would recommend that the traditional view to manage all silent corticotroph adenomas with adjuvant radiation should be reconsidered. We suggest adopting an initially more conservative follow-up surveillance and delay of upfront radiation until there is clear evidence of tumor recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ACTH:

Adrenocorticotropic hormone

CRH:

Corticotropin-releasing hormone

CS:

Cavernous sinus

GH:

Growth hormone

IGF-1:

Insulin-like growth factor 1

MRI:

Magnetic resonance imaging

NFAs:

Non-functional adenomas

SCAs:

Silent corticotroph adenomas

UFC:

Urinary free cortisol

References

  1. Baldeweg SE, Pollock JR, Powell M, Ahlquist J (2005) A spectrum of behaviour in silent corticotroph pituitary adenomas. Br J Neurosurg 19(1):38–42

    Article  PubMed  CAS  Google Scholar 

  2. Black PM, Hsu DW, Klibanski A, Kliman B, Jameson JL, Ridgway EC, Hedley-Whyte ET, Zervas NT (1987) Hormone production in clinically nonfunctioning pituitary adenomas. J Neurosurg 66(2):244–250

    Article  PubMed  CAS  Google Scholar 

  3. Bradley KJ, Wass JA, Turner HE (2003) Non-functioning pituitary adenomas with positive immunoreactivity for ACTH behave more aggressively than ACTH immunonegative tumours but do not recur more frequently. Clin Endocrinol (Oxf) 58(1):59–64

    Article  CAS  Google Scholar 

  4. Cho HY, Cho SW, Kim SW, Shin CS, Park KS, Kim SY (2010) Silent corticotroph adenomas have unique recurrence characteristics compared with other nonfunctioning pituitary adenomas. Clin Endocrinol (Oxf) 72(5):648–653

    Article  Google Scholar 

  5. Horvath E, Kovacs K, Killinger DW, Smyth HS, Platts ME, Singer W (1980) Silent corticotropic adenomas of the human pituitary gland: a histologic, immunocytologic, and ultrastructural study. Am J Pathol 98(3):617–638

    PubMed  CAS  Google Scholar 

  6. Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33(4):610–617

    Article  PubMed  CAS  Google Scholar 

  7. Kontogeorgos G, Scheithauer BW, Horvath E, Kovacs K, Lloyd RV, Smyth HS, Rologis D (1992) Double adenomas of the pituitary: a clinicopathological study of 11 tumors. Neurosurgery 31(5):840–9

    Article  PubMed  CAS  Google Scholar 

  8. Kovacs K, Horvath E, Stefaneanu L, Bilbao JM, Singer W (1999) Two cases of pituitary Crooke’s cell adenoma without Cushing’s disease: a histologic, immunohistochemical, electron microscopic and in situ hybridization study. Endocr Pathol 10(1):65–72

    Article  Google Scholar 

  9. Lopez JA, Kleinschmidt-Demasters Bk B, Sze CI, Woodmansee WW, Lillehei KO (2004) Silent corticotroph adenomas: further clinical and pathological observations. Hum Pathol 35(9):1137–1147

    Article  PubMed  Google Scholar 

  10. Nagaya T, Seo H, Kuwayama A, Sakurai T, Tsukamoto N, Nakane T, Sugita K, Matsui N (1990) Pro-opiomelanocortin gene expression in silent corticotroph-cell adenoma and cushing’s disease. J Neurosurg 72(2):262–267

    Article  PubMed  CAS  Google Scholar 

  11. Pawlikowski M, Kunert-Radek J, Radek M (2008) “Silent” corticotropinoma. Neuro Endocrinol Lett 29(3):347–350

    PubMed  Google Scholar 

  12. Raverot G, Wierinckx A, Jouanneau E, Auger C, Borson-Chazot F, Lachuer J, Pugeat M, Trouillas J (2010) Clinical, hormonal and molecular characterization of pituitary ACTH adenomas without (silent corticotroph adenomas) and with Cushing’s disease. Eur J Endocrinol 163(1):35–43

    Article  PubMed  CAS  Google Scholar 

  13. Roncaroli F, Faustini-Fustini M, Mauri F, Asioli S, Frank G (2002) Crooke’s hyalinization in silent corticotroph adenoma: report of two cases. Endocr Pathol 13(3):245–249

    Article  PubMed  Google Scholar 

  14. Sahli R, Christ ER, Seiler R, Kappeler A, Vajtai I (2006) Clinicopathologic correlations of silent corticotroph adenomas of the pituitary: report of four cases and literature review. Pathol Res Pract 202(6):457–464

    Article  PubMed  Google Scholar 

  15. Scheithauer BW, Jaap AJ, Horvath E, Kovacs K, Lloyd RV, Meyer FB, Laws ER Jr, Young WF Jr (2000) Clinically silent corticotroph tumors of the pituitary gland. Neurosurgery 47(3):723–729

    PubMed  CAS  Google Scholar 

  16. Webb KM, Laurent JJ, Okonkwo DO, Lopes MB, Vance ML, Laws ER Jr (2003) Clinical characteristics of silent corticotrophic adenomas and creation of an Internet-accessible database to facilitate their multi-institutional study. Neurosurgery 53(5):1076–1084

    Article  PubMed  Google Scholar 

  17. Yamada S, Ohyama K, Taguchi M, Takeshita A, Morita K, Takano K, Sano T (2007) A study of the correlation between morphological findings and biological activities in clinically nonfunctioning pituitary adenomas. Neurosurgery 61(3):580–584

    Article  PubMed  Google Scholar 

  18. Ueyama T, Tamaki N, Kondoh T, Kurata H (1998) Large and invasive silent corticotroph-cell adenoma with elevated serum ACTH: a case report. Surg Neurol 50(1):30–31

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada

    Hussein Alahmadi, Daniel Lee, Jefferson R. Wilson, Caroline Hayhurst, Fred Gentili & Gelareh Zadeh

  2. Department of Pathology, University Health Network, University of Toronto, Toronto, Canada

    Ozgur Mete & Sylvia L. Asa

  3. Toronto Western Hospital, 4th floor, WW, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada

    Hussein Alahmadi

Authors
  1. Hussein Alahmadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jefferson R. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Caroline Hayhurst
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ozgur Mete
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fred Gentili
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sylvia L. Asa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gelareh Zadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hussein Alahmadi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alahmadi, H., Lee, D., Wilson, J.R. et al. Clinical features of silent corticotroph adenomas. Acta Neurochir 154, 1493–1498 (2012). https://doi.org/10.1007/s00701-012-1378-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-012-1378-1

Keywords

Search

Navigation