title: Silent corticotroph adenomas: Emory University cohort and comparison with ACTH-negative nonfunctioning pituitary adenomas.
abstract: BACKGROUND
  Silent corticotroph adenomas (SCAs) are clinically nonfunctioning pituitary adenomas (NFPAs) with positive staining for corticotropin (ACTH) by immunohistochemistry. Whether SCAs behave more aggressively than NFPAs without ACTH immunoreactivity (ACTH negative) remains controversial.
  
  
  OBJECTIVE
  To compare characteristics and outcomes of SCAs with ACTH-negative NFPAs and to identify predictors of aggressive outcome. Primary composite endpoint included the first of any of the following events: progression, recurrence, or death.
  
  
  METHODS
  We reviewed all cases of SCAs and all ACTH-negative macroadenomas operated on between April 1995 and December 2007 by 1 neurosurgeon.
  
  
  RESULTS
  Our retrospective cohorts included 33 SCAs followed for 42.5 months (median) (range, 6.7-179.0 months) and 126 ACTH-negative patients followed for 42 months (range, 6-142 months). SCA were younger (mean ± SD; 49.6 ± 14.1) than ACTH-negative patients (55.6 ± 12.8, P = .02). Tumor diameter was similar (2.8 ± 1.0 cm); cavernous sinus invasion was present in 45.5% of SCAs and 30.2% of ACTH-negative NFPAs (P = .09). Postoperative tumor residual was detected in 53.1% of SCAs and 49.6% of ACTH-negative patients. Radiation was administered in 40.6% of SCAs at 16 months (range, 3-149 months) and 33.3% of ACTH-negative patients at 13 months (range, 3-94) postoperatively. Progression of residual tumor occurred in 24.2% of SCAs and 11.1% of ACTH-negative patients (P = .08); recurrence was similar (6.0% SCAs vs 5.5% ACTH-negative patients). Cumulative event-free survival rates were not significantly different between the 2 groups (P = .3). Age, sex, tumor size, cavernous sinus invasion, or SCA subtypes were not associated with outcome.
  
  
  CONCLUSIONS
  SCA patients were younger, but exhibited similar postoperative tumor regrowth rates as ACTH-negative macroadenomas while using a similar adjuvant radiation protocol. Long-term follow-up is warranted because predictors of regrowth are currently lacking.
authors.affiliation: Department of Medicine, Emory University, Atlanta, Georgia 30322, USA. aioachi@emory.edu
authors.forename: Adriana G
authors.initials: AG
authors.lastname: Ioachimescu
authors.forename: Leslie
authors.initials: L
authors.lastname: Eiland
authors.forename: Vaninder S
authors.initials: VS
authors.lastname: Chhabra
authors.forename: Gena M
authors.initials: GM
authors.lastname: Mastrogianakis
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schniederjan
authors.forename: Daniel
authors.initials: D
authors.lastname: Brat
authors.forename: Anthony V
authors.initials: AV
authors.lastname: Pileggi
authors.forename: Nelson M
authors.initials: NM
authors.lastname: Oyesiku
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000378:metabolism* / Q000601:surgery*; D000236:Adenoma / Q000378:metabolism* / Q000601:surgery*; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000324:Adrenocorticotropic Hormone