title: Prevalence of clinically silent corticotroph macroadenomas.
abstract: OBJECTIVE
  The prevalence of clinically silent corticotroph macroadenomas is unknown. Our aim was to determine the prevalence of clinically silent corticotroph macroadenomas among all pituitary macroadenomas.
  
  
  METHODS
  Patients scheduled to have transsphenoidal surgery for any sellar mass were prospectively evaluated clinically and biochemically.
  
  
  METHODS
  Adults who were scheduled for transsphenoidal surgery for a sellar mass at a single academic medical centre.
  
  
  METHODS
  Patients were assessed clinically prior to surgery and graded as having typical, mild or no Cushingoid features. They were assessed biochemically by plasma ACTH and 24-h urine free cortisol (UFC). Excised tissue was examined histologically, and pituitary macroadenomas, examined by immunohistochemistry. Patients with corticotroph macroadenomas were classified as clinically silent if they exhibited no Cushingoid features but had elevated plasma ACTH and/or 24-h UFC. They were classified as totally silent if they exhibited neither Cushingoid features nor elevated plasma ACTH or 24-h UFC.
  
  
  RESULTS
  Of 124 patients who had pathologically confirmed pituitary macroadenomas, 20 (16%) had corticotroph macroadenomas. Eight (40%) of these were clinically silent, in that they had no Cushingoid features but could be identified biochemically by elevated plasma ACTH (seven) and/or 24-h UFC (three). Five (25%) were totally silent.
  
  
  CONCLUSIONS
  A substantial minority (16%) of pituitary macroadenomas treated surgically are corticotroph adenomas. Of these, 40% are clinically silent but can be recognized by elevated plasma ACTH and/or 24-h UFC. Recognizing these adenomas may influence the surgical approach and provide a marker by which to follow the response to treatment.
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Katie B
authors.initials: KB
authors.lastname: Guttenberg
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Mayson
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Carla
authors.initials: C
authors.lastname: Sawan
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Kharlip
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: John Y
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Departments of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Martinez-Lage
authors.affiliation: Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Loevner
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jayme
authors.initials: J
authors.lastname: Ewanichak
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: M Sean
authors.initials: MS
authors.lastname: Grady
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Snyder
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000175:diagnosis* / Q000453:epidemiology; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis / Q000473:pathology; D010911:Pituitary Neoplasms / Q000453:epidemiology / Q000601:surgery; D015995:Prevalence
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone