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

Fabienne Langlois, Dawn Shao Ting Lim, Christine (Chris) Yedinak, Isabelle Cetas, Shirley McCartney, Justin Cetas, Aclan Dogan, Maria Fleseriu

Research output: Contribution to journalArticle

12 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalPituitary
DOIs
StateAccepted/In press - Oct 14 2017

Fingerprint

ACTH-Secreting Pituitary Adenoma
Recurrence
Gonadotrophs
Adenoma
Adrenocorticotropic Hormone
Sphenoid Sinus
Cavernous Sinus
Cushing Syndrome
PubMed

Keywords

  • Cushing’s disease
  • Gonadotroph
  • Nonfunctioning
  • Pituitary adenoma
  • Silent corticotroph

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

@article{00397d1cb1b140ddb5f7c7c019bda74b,
title = "Predictors of silent corticotroph adenoma recurrence; a large retrospective single center study and systematic literature review",
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.",
keywords = "Cushing’s disease, Gonadotroph, Nonfunctioning, Pituitary adenoma, Silent corticotroph",
author = "Fabienne Langlois and Lim, {Dawn Shao Ting} and Yedinak, {Christine (Chris)} and Isabelle Cetas and Shirley McCartney and Justin Cetas and Aclan Dogan and Maria Fleseriu",
year = "2017",
month = "10",
day = "14",
doi = "10.1007/s11102-017-0844-4",
language = "English (US)",
pages = "1--9",
journal = "Pituitary",
issn = "1386-341X",
publisher = "Kluwer Academic Publishers",

}

TY - JOUR

T1 - Predictors of silent corticotroph adenoma recurrence; a large retrospective single center study and systematic literature review

AU - Langlois, Fabienne

AU - Lim, Dawn Shao Ting

AU - Yedinak, Christine (Chris)

AU - Cetas, Isabelle

AU - McCartney, Shirley

AU - Cetas, Justin

AU - Dogan, Aclan

AU - Fleseriu, Maria

PY - 2017/10/14

Y1 - 2017/10/14

N2 - 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.

AB - 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.

KW - Cushing’s disease

KW - Gonadotroph

KW - Nonfunctioning

KW - Pituitary adenoma

KW - Silent corticotroph

UR - http://www.scopus.com/inward/record.url?scp=85031428815&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85031428815&partnerID=8YFLogxK

U2 - 10.1007/s11102-017-0844-4

DO - 10.1007/s11102-017-0844-4

M3 - Article

C2 - 29032459

AN - SCOPUS:85031428815

SP - 1

EP - 9

JO - Pituitary

JF - Pituitary

SN - 1386-341X

ER -