Endocrine Abstracts

Introduction: Silent corticotroph adenomas (SCAs) are uncommon pituitary tumors, immunoreactive for ACTH, but without clinical evidence of hypercortisolism and present with local mass effects and some endocrine dysfunction. Case 43 years old male patient was diagnosed with pituitary tumor which was 5×3 cm in size. In history, 6 months ago he applied to another hospital with syncope and operated transsphenoidally. But these datas are unreachable. He had been suffering from weakness, impotence under the medication of testosterone and levothyroxine. There were no clinical symptoms about Cushing Syndrome. It was accepted as recurrent pituitary tumor and we decided to pterional craniotomy operation under the stress dose steroid treatment. Pre and postoperative, the hormone levels were found as ACTH: 151.34 (5–60 pg/mL), cortisol: 11.4, 0.89 (3.09–16.6 μg/dL), prolactin: 6.7, 9.27 (5.8–7.2 ng/mL), fT4: 0.94, 1.46 (0.89–1.76 ng/dL), total testosterone:176, 124 (241–827 ng/dL), IGF-1:183, 139 (101–267 ug/L), FSH: 2.3, 0.831 (1.4–18.1 IU/L), LH: 2, 0.123 (1.5–9.3 IU/L), respectively. In histopathological examination adenoma showing positive staining for ACTH diffuse (+), GH (−), FSH (−), LH (−), Prolactin (−), p53: %1 (+), Ki67 proliferation index: %3. By asking him to come to the controls, he was discharged with desmopressin, levothyroxine, hydrocortisone and testosterone replacement treatment.

Discussion: SCAs are very rare pituitary mass lesions. SCAs stain for ACTH, but do not secrete sufficient ACTH to cause Cushing disease. Like this case, SCAs carry a more aggressive biological behavior, increasing in size and higher potential for recurrence.