title: Silent GH pituitary tumor: diagnostic and therapeutic challenges.
abstract: Silent GH pituitary tumors are characterized by the absence of clinical features of acromegaly, normal to slightly elevated GH and/or IGF-1 levels, as well as immunohistochemical expression of GH. The diagnostic and the therapeutic challenges of these "silent" GH tumors are illustrated in this case report, supported by a literature review. A 20-year-old woman presented with visual disturbances related to an invasive macroadenoma but without clinical and biological signs of GH hypersecretion. After two surgeries, a residual tumor remained in the right cavernous sinus. According to the recent classifications, the histopathological diagnosis was a sparsely GH-PRL atypical adenoma or invasive and proliferative (Ki-67 index: 4%) and p53 positive (1%) grade 2b tumor, with high expression (>75% of the cells) of somatostatin receptors type 2A and 5. From this case and the review of the literature, an invasive macroadenoma in young women requires: the preoperative determination of plasma GH and IGF-1, the immunohistochemical detection in the tumor of GH, PRL, somatostatin receptor expression and the evaluation of the proliferation (mitoses count, Ki-67 and p53 indexes). The suspicion of an aggressive behavior needs a particular follow-up. In the case of tumor remnant, a postoperative treatment such as radiotherapy and/or somatostatin analogs must be considered.
authors.affiliation: Department of Histology, University of Medicine and Pharmacy, Tirgu Mures 540139, Romania.
authors.forename: Laura
authors.initials: L
authors.lastname: Chinezu
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Jouanneau
authors.forename: Alexandre
authors.initials: A
authors.lastname: Vasiljevic
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Trouillas
authors.forename: Gérald
authors.initials: G
authors.lastname: Raverot
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000628:therapy*; D058070:Asymptomatic Diseases; D003937:Diagnosis, Differential; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods; D010911:Pituitary Neoplasms / Q000175:diagnosis*; D015175:Prolactinoma / Q000175:diagnosis* / Q000628:therapy; D013100:Sphenoid Bone / Q000601:surgery; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology; D055815:Young Adult