ECE2020 Audio ePoster Presentations Pituitary and Neuroendocrinology (217 abstracts)
Silent corticotroph adenoma: Experience with six cases
Guillermo Serra Soler 1 , Carlos Antich Barceló 1 , Javier Bodoque Cubas 1 , Honorato García Fernández 1 , Antonio Mas Bonet 2 , Ester Antón Valentí 3 , Elena Mena Ribas 1 , Santiago Tofé Povedano 1 , Iñaki Argüelles Jiménez 1 & Vicente Pereg Macazaga 1
1Hospital Universitary Son Espases, Endocrinology, Palma de Mallorca, Spain Endocrinology, Palma, Spain; 2Hospital Universitary Son Espases, Radiology, Palma, Spain; 3Hospital Universitary Son Espases, Anatomical Pathology, Palma de Mallorca, Spain
Introduction: Silent corticotroph adenomas (SCA) represent a subtype of pituitary adenomas whose prevalence is 3% of pituitary adenomas. They are characterized by having a positive immunohistochemistry to corticotropin (ACTH) without clinical or biochemical data of hypercortisolism. The diagnosis is a challenge since they are considered as ANF, and it is with the pathology report after surgery when they are classified as SCA. They have more aggressive behavior and recur more than ANF
Case report: Of the 129 pituitary adenomas operated on in our hospital in the last ten years (2009 – 2019), six SCA were found. The average age was 58.8 years (45 – 72) and 4/6 cases (67%) were women. All were macroadenomas, with an average size of 27 mm ± 8, with headaches in 5/6 (83%) and visual disturbances in 5/6 (83%). None of them showed signs and/or symptoms of hypercortisolism. Type 1 SCA was found in 3/6 (50%) and type 2 in the other 50%. The average preoperative ACTH value was 59 pg/ml ± 29, with an average cortisol of 13 µg/dl ± 2. Four out of six cases (67%) had high ACTH levels and all had normal plasma cortisol. Five of six cases (83%) had invasion of cavernous sinus and 2/6 (33%) suffered an apoplexy. Knosp’s grade of cavernous sinus invasion was equal to or greater than 3 in 4/6 cases (67%). Multiple microcysts were found in the T2 sequence of pituitary MRI in 5/6 cases (83%), a liquid content of less than 50% in 4/6 (67%) and more than 50% in 2/6. Five of six cases (83%) presented with preoperative hypogonadotropic hypogonadism. Two of six cases (33%) presented “de novo” postoperative hypopituitarism. The average follow-up time was 37 months (3–78). Of six cases, two experienced a progression after surgery, one had a stable remnant, two did not have a remnant and one waiting for the pituitary MRI. The two cases that progressed had highervalues of ACTH, Knosp’s grade and Ki-67, with less than 50% liquid content. Both required radiotherapy and one of them a second surgery
Conclusions: – SCA are a subtype of pituitary adenomas whose diagnosis regarding ANF is difficult. A high preoperative ACTH value and/or the presence of multiple microcysts in the T2 sequence of pituitary MRI could make us suspect the existence of SCA
– Because of the greater recurrence, SCA require closer clinical and radiological follow-up and an evaluation by a multidisciplinary team
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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