Study Describes Clinical Features that May Help Distinguish Silent Corticotroph Adenomas

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by Alice Melao |

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Researchers have identified several parameters that could help distinguish silent corticotroph adenomas — benign pituitary tumors that produce adrenocorticotropic hormone — from other nonfunctioning pituitary tumors.

Because these tumors usually have a more aggressive clinical course, the findings may help determine the most appropriate management approach for patients before they undergo surgery.

The study, “Clinical Parameters to Distinguish Silent Corticotroph Adenomas from Other Nonfunctioning Pituitary Adenomas,” was published in the journal World Neurosurgery.

Silent corticotroph adenomas (SCAs) are clinically considered nonfunctioning pituitary benign tumors (NFPAs) — pituitary tumors that do not express excess hormones — that stain positive for adrenocorticotropic hormone (ACTH) on tissue analysis.

They are not associated with Cushing’s disease, but may lead to headaches, visual impairments, and hypopituitarism, or reduced activity of the pituitary gland.

While NFPAs are usually treated with surgery, SCAs are more aggressive and are associated with earlier and more frequent recurrences. In some cases, SCAs may return as functioning adenomas that cause Cushing’s disease.

Distinguishing SCAs from other NFPAs could improve the treatment and management of these patients.

In an attempt to find factors that helped distinguish both kinds of tumors, researchers at the Yonsei University College of Medicine in Korea reviewed the medical records of 341 patients who had surgery for a nonfunctioning pituitary benign tumor.

All patients had normal cortisol levels, and 37 had a silent corticotroph adenoma.

Women developed SCAs more frequently than men — 89.2% vs. 57.6% — as did patients whose tumors had invaded through the cavernous sinus – the brain structure surrounding the pituitary gland. Additionally, more patients with SCAs had bleeding inside their tumors, compared with those who didn’t have SCAs.

Similarly, patients with lower levels of ACTH in response to low blood sugar in a pre-operative pituitary function test also developed the condition more frequently than those with normal responses in this test.

An additional analysis showed that these four factors — female gender, cavernous sinus invasion, intratumoral bleeding, and low ACTH response — were all independently associated with SCAs.

“Our data provide evidence that female sex, cavernous sinus invasion, intratumoral hemorrhage on sella MRI, and decreased ACTH response in the CPFT are significantly associated with SCAs,” the investigators concluded. “These findings may help to decide the proper management strategy and treatment approaches for patients with clinical NFPAs before surgery.”