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Pituitary
Published in: Pituitary 1/2018

01-02-2018

Predictors of silent corticotroph adenoma recurrence; a large retrospective single center study and systematic literature review

Authors: Fabienne Langlois, Dawn Shao Ting Lim, Chris G. Yedinak, Isabelle Cetas, Shirley McCartney, Justin Cetas, Aclan Dogan, Maria Fleseriu

Published in: Pituitary | Issue 1/2018

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Abstract

Purpose

Silent corticotroph adenomas (SCAs) are clinically silent and non-secreting, but exhibit positive adrenocorticotropic hormone (ACTH) immunostaining. We characterized a single center cohort of SCA patients, compared the SCAs to silent gonadotroph adenomas (SGAs), identified predictors of recurrence, and reviewed and compared the cohort to previously published SCAs cases.

Methods

Retrospective review of SCA and SGA surgically resected patients over 10 years and 6 years, respectively. Definitions; SCA—no clinical or biochemical evidence of Cushing’s syndrome and ACTH positive immunostaining, and SGA—steroidogenic factor (SF-1) positive immunostaining. A systematic literature search was undertaken using Pubmed and Scopus.

Results

Review revealed 814 pituitary surgeries, 39 (4.8%) were SCAs. Mean follow-up was 6.4 years (range 0.5–23.8 years). Pre-operative magnetic resonance imaging demonstrated sphenoid and/or cavernous sinus invasion in 44%, 33% were > 50% cystic, and 28% had high ACTH levels pre-operatively. Compared to SGAs (n = 70), SCAs were of similar size and invasiveness (2.5 vs. 2.9 cm, p = 0.2; 44 vs. 41%, p = 0.8, respectively), but recurrence rate was higher (36 vs. 10%, p = 0.001) and more patients received radiation therapy (18 vs. 3%, p = 0.006). Less cystic tumors (0 vs. 50%, p < 0.001) and higher pre-operative ACTH levels (54 vs. 28 pg/ml, p = 0.04) were predictors of recurrence for SCAs.

Conclusion

This review is unique; a strict definition of SCA was used, and single center SCAs were compared with SGAs and with SCAs literature reviewed cases. We show that SCAs are aggressive and identify predictors of recurrence. Accurate initial diagnosis, close imaging and biochemical follow up are warranted.
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Metadata
Title
Predictors of silent corticotroph adenoma recurrence; a large retrospective single center study and systematic literature review
Authors
Fabienne Langlois
Dawn Shao Ting Lim
Chris G. Yedinak
Isabelle Cetas
Shirley McCartney
Justin Cetas
Aclan Dogan
Maria Fleseriu
Publication date
01-02-2018
Publisher
Springer US
Published in
Pituitary / Issue 1/2018
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-017-0844-4

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