Endocrine Abstracts

Silent Corticotroph Adenomas (SCAs) are a type of pituitary tumor that is discovered without obvious clinical symptoms. SCAs are considered to be one of the five "high-risk" tumors due to their aggressive behavior, characterized by high levels of proliferation, rapid progression, and recurrence. Unlike functional corticotropin adenomas, SCAs do not exhibit any clinical or biochemical signs of hypercortisolemia. When the tumor is detected, it often exhibits invasive growth and poses a challenge for complete surgical excision. Positive immunoreactivity for ACTH or/and T-PIT in the pathological examination of the resected tumor after surgery may be the only evidence for the diagnosis of SCAs. The introduction of pituitary-restricted transcription factor (T-PIT) has enhanced the diagnostic precision of SCAs. Even cell lineage-specific pituitary transcription factors are the only diagnostic basis, as shown in case 3, ACTH expression is negative and finally diagnosed by positive T-PIT expression. Currently, the management of intractable SCAs remains an active subject of investigation. This article discusses three clinical cases and conducts a literature review to underscore the significance of timely radiotherapy after surgical intervention for residual or recurrent tumors. Therefore, our patients in this article received adjuvant radiotherapy after surgery. Unfortunately, the patient of case 1 could not be relieved even after surgery and twice gamma knife treatment and required a second operation. Nevertheless, the prognosis of case 3 was better than that of the first two patients after radiotherapy because early intervention was determined once diagnosis of SCA was confirmed. The management of refractory SCAs remains an area of ongoing exploration. Aggressive macroadenomas usually have low expression of O6 -methylguanine-DNA methyltransferase in Cushing’s Disease. Therefore, temozolomide (TMZ) may be a novel therapeutic option to treat invasive pituitary tumors. The European Society of Endocrinology has adopted TMZ as the primary therapy for invasive pituitary tumors that have not responded to conventional treatment. In case 1, there was no significant tumor growth after TZM treatment. This article underscores the potential of TMZ as an alternative in cases resistant to conventional therapies.