ECE2023 Eposter Presentations Pituitary and Neuroendocrinology (234 abstracts)
Silent pituitary macroadenomas – clinical behavior and prognosis
Inês Manique 1 , Sara Amaral 1 , Ana Palha 1 , Luísa Cortez 1 , Luís Cerqueira 2 , Amets Sagarribay 3 & José Silva-Nunes 1
1Centro Hospitalar Universitário de Lisboa Central, Endocrinology, Lisboa, Portugal; 2Centro Hospitalar Universitário de Lisboa Central, Neuroradiology, Lisboa, Portugal; 3Centro Hospitalar Universitário Lisboa Central, Neurosurgery, Lisboa, Portugal
Introduction: A third of pituitary adenomas are non-functioning. Classification depends on adenohypophyseal hormones expression and transcription factors.
Aim: Characterize silent pituitary macroadenomas cases regarding their clinical data, treatment, histopathology and prognosis.
Methods: We revised clinical process of patients followed in CHULC. Cases with non-access to clinical follow-up registries or exams were excluded.
Results: Sixty-five patients (69.2% male), diagnosed at 53.6±14.3 years-old, followed during 6.6±4.4 years. 58.5% (n=38) were diagnosed in the context of tumoral mass effect; 21.5% (n=14) hypopituitarism; 9.2% (n=6) pituitary apoplexy and 10,8% (n=7) as an incidentaloma. 33,8% (n=22) had visual fields alterations with bitemporal hemianopsia being the commonest (9%; n=16). The characteristics of the different cases are summarized in Table 1 .
| Gonadotropinomas | |||||||||
| FSH/FSH +LH | FSH-/LH-SF1+ | ACTH | TSH | PRL | FSH+LH+TSH | FSH+ACTH+PRL | GH+TSH | PRL+GH | |
| Number | 44 (67,7%) | 5 (7,7%) | 6 (9,2%) | 2 (3,1%) | 1 (1,5%) | 4 (6,2%) | 1 (1,5%) | 1 (1,5%) | 1 (1,5%) |
| Dimension (mm) | 29,7±7,1 | 30,7±12,8 | 28,5±6,9 | 27,5±6,4 | 23 | 34,2±6,8 | 41 | 24 | 37 |
| Extension | |||||||||
| suprasellar | 43 | 2 | 6 | 2 | 1 | 4 | 1 | 1 | 1 |
| infrasellar | 16 | 1 | 2 | 0 | 0 | 1 | 1 | 0 | 0 |
| parasellar | 29 | 1 | 6 | 0 | 1 | 4 | 1 | 1 | 1 |
| Knosp | |||||||||
| 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 1 | 7 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 0 |
| 2 | 22 | 1 | 4 | 1 | 1 | 0 | 0 | 0 | 0 |
| 3A | 11 | 2 | 0 | 0 | 0 | 2 | 0 | 0 | 1 |
| 3B | 1 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 |
| 4 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Optic chiasm contact/compression | 41 | 4 | 6 | 2 | 1 | 4 | 1 | 1 | 1 |
| Sphenoid sinus invasion | 5 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 |
| Number of Surgeries | 1,22±0,6 | 1 | 2,3±1,7 | 2 | 1 | 1,25±0,5 | 2 | 1 | 1 |
| Ki 67 | <3% (n=42) 3–10% (n=2) | <3% (n=5) | <3% (n=4) 3–10% (n=2)1 | <3% (n=2) | <3% (n=1) | <3% (n=4) | <3% (n=1) | <3% (n=1) | 3–10% (n=1) |
| Cabergoline | 5 | 2 | 0 | 0 | 1 | 0 | 0 | 0 | 1 |
| Radiotheraoy | 1 | 0 | 2 | 1 | 0 | 1 | 0 | 0 | 0 |
| *In a silent corticotropinoma operated 5 times, Ki-67 increased in the successive histopathologic evaluations reaching 25%. | |||||||||
Conclusion: As expected, silent gonadotropinomas were the most prevalent and all the hormone negative adenomas expressed SF1. Although most of silent adenomas have a good prognosis, silent corticotropinomas seems to be more challenging to treat. Histopathology is decisive to predict the prognosis.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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