Silent corticotroph adenomas have unique recurrence characteristics compared with other nonfunctioning pituitary adenomas.
OBJECTIVE
The prevalence of silent corticotroph adenomas (SCAs) is not rare among nonfunctioning pituitary adenomas (NFPAs); however, it is unknown whether the clinical significance of SCAs differs from that of NFPAs without ACTH immunoreactivity (non-SCAs). Our goal was to compare the clinical characteristics and natural history between patients with SCAs and non-SCAs.


METHODS
We reviewed the medical records of all patients who underwent transsphenoidal surgery for NFPAs from January 1990 to October 2007 at the Seoul National University Hospital.


METHODS
We analysed whether clinical manifestations at diagnosis, postoperative recurrence rate and recurrence characteristics differed between SCA and non-SCA patients.


RESULTS
In total, 28 patients with SCAs and 134 patients with non-SCAs were analysed. The mean age at the time of diagnosis was 44 years (range, 13-67 years) in the SCA group and 50 years (18-79 years) in the non-SCA group (P = 0.026), with respective follow-up periods of 5.2 (range, 1.0-16.0 years) and 4.2 years (0.5-16.1 years) (P = 0.255). Overall recurrence rates of SCAs and non-SCAs were 25.0% and 26.9% respectively (P = 0.839). More than two recurrences (P = 0.001) and recurrence after more than 5 years (P = 0.040) were associated with SCAs. Multiple recurrences of SCAs were confined to younger patients.


CONCLUSIONS
The overall recurrence rate was similar between SCAs and non-SCAs. However, young patients with SCAs had a higher frequency of multiple and late recurrences, which showed more aggressive tumour behaviour. Therefore, we suggest that patients with SCAs, especially patients diagnosed at a young age, require careful long-term monitoring.
Cho
Hwa Young
HY
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Cho
Sun Wook
SW
Kim
Sang Wan
SW
Shin
Chan Soo
CS
Park
Kyong Soo
KS
Kim
Seong Yeon
SY
D000236:Adenoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000032:analysis*; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D000324:Adrenocorticotropic Hormone