Silent, but not unseen: multimicrocystic aspect on <scp>T</scp>2‐weighted <scp>MRI</scp> in silent corticotroph adenomas

Cazabat, Laure; Dupuy, M.; Boulin, A.; Bernier, Michèle; Baussart, Bertrand; Foubert, L.; Raffin-Sanson, Marie-Laure; Caron, Philippe; Bertherat, Jérôme; Gaillard, Stéphan

doi:10.1111/cen.12443

Cited by 44 publications

(39 citation statements)

References 27 publications

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“…A recent report proposes that the presence of multiple microcysts on T2‐weighted MRI images distinguishes silent corticotroph macroadenomas from other types of macroadenomas . In the present study, however, although 87·5% of clinically silent corticotroph macroadenomas had multiple microcysts, so did 90% of null cell macroadenomas and 80% of gonadotroph macroadenomas.…”

Section: Discussioncontrasting

confidence: 81%

Prevalence of clinically silent corticotroph macroadenomas

Guttenberg

Mayson

Sawan

et al. 2016

Clinical Endocrinology

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Section: Discussioncontrasting

confidence: 81%

Prevalence of clinically silent corticotroph macroadenomas

Guttenberg

Mayson

Sawan

et al. 2016

Clinical Endocrinology

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“…Radiologic features are generally similar between SCAs and NFAs [9,10,19,43] though cavernous sinus invasion may be more prevalent in SCAs than in nonfunctioning adenomas [4,20,49,50,63]. One group identified multiple microcysts (<3 mm) of high intensity signal on T2 weighted images in 77% of SCAs compared 21% in CD and 5% of NFAs, and macrocysts in 23% of SCAs [7]. Further, SCAs may have higher rates of intratumoral hemorrhage [9].…”

Section: Clinical Coursementioning

confidence: 99%

Silent corticotroph adenomas

2018

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Purpose-Silent corticotroph adenomas (SCAs) comprise 20% of all corticotroph adenomas and 3-19% of nonfunctioning adenomas (NFAs). As they do not manifest clinical or biochemical hypercortisolism, they are diagnosed after pathologic examination of resected tumor tissue demonstrates positive ACTH expression. While preoperative features are similar to those of NFAs, SCAs may have more cavernous sinus invasion. Further, patients with SCAs tend to have more frequent and earlier recurrences than those with NFAs, often necessitating multiple surgeries and other modalities of treatment. This article reviews the incidence, pathogenesis, and clinical behavior of SCAs.Methods-A systematic literature review was performed using PubMed for information regarding silent corticotroph adenomas.Results-Up to date findings regarding epidemiology, pathogenesis, pathology, clinical presentation, postoperative course, and management of patients with SCAs are presented.Conclusions-This review highlights the necessity of rigorous monitoring for recurrences and hypopituitarism in patients with SCAs.

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“…Langlois et al reported a case series of SCAs (n = 39), and 33% of cases demonstrated >50% fluid content on MRI T2-phase sequences (37). Cazabat et al reported that cystic changes could be found in all SCAs (n = 17), half of corticotroph macroadenomas (n = 14), and only 17% of silent gonadotroph macroadenomas (n = 60) on T2-weighted pituitary MRI sequences in their case series (38). Multiple microcysts were present in most SCAs (13/17, 76.5%), and macrocysts were observed in the remaining four SCAs (4/17, 23.6%).…”

Section: Discussionmentioning

confidence: 95%

Clinical, Laboratory, and Treatment Profiles of Silent Corticotroph Adenomas That Have Transformed to the Functional Type: A Case Series With a Literature Review

et al. 2020

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Purpose: Silent corticotroph adenoma (SCA) is clinically non-functional pituitary adenoma with expression of corticotropin or Tpit. To further understand the characteristics of this rare type of SCA transforming to a functional SCA, we retrospectively reviewed SCAs that converted to typical Cushing's syndrome at a tertiary medical center and the relevant literature. Methods: Patients were identified based on the diagnosis of pituitary adenoma without symptoms of hypercortisolism at the initial visit with positive Immunohistochemical (IHC) staining for corticotropin or Tpit after surgery and subsequent transformation to functional SCAs during the follow-up period from March 1990 to January 2020 at Peking Union Medical College Hospital and in the literature. The characteristics of the clinical manifestations, biochemical results, imaging findings, pathology findings and outcome were analyzed. Results: Altogether, 16 patients were included in the study with an average age of 42.0 ± 12.48 (18-65) years at the first visit. Females were slightly predominant (F:M = 1.3:1). The median time of conversion from the nonfunctional to the functional type was 30 (13.0, 68.3) months. Once a functional SCA developed, the adrenocorticotropic hormone (ACTH) level and 24-h urine free cortisol were increased 3.8-(2.6, 12.9) and 5.3-(2.6, 19.3) fold, respectively, above the normal range. Approximately 50% of the patients had macrocystic changes on pituitary MRI. All 16 patients experienced 1-5 surgeries with a median of 2.5 (2.0, 4.0) surgeries. The proportion of patients with Ki-67 ≥ 3% increased from 22.2% (2/9) at the beginning to 50% (7/14) at the time of functional SCA diagnosis. Thirteen patients received radiotherapy, and 4 patients (30.8%) achieved remission. Four patients with refractory functional SCAs received temozolomide treatment with the normalization of cortisol in 4 cases and reduced tumor volume in 3 cases. Zheng et al. Clinical Features of SCA Transforming to Functional Conclusion: In this study, all cases that transformed to functional SCAs were macroadenomas. Hypercortisolism was more severe in functional SCA patients. The tumors tended to have frequent recurrence and were highly invasive. Temozolomide could be a promising treatment for refractory functional SCA cases. Long-term follow-up is needed for nonfunctional SCAs since some cases have the potential to transform to clinical Cushing's syndrome.

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Silent, but not unseen: multimicrocystic aspect on T2‐weighted MRI in silent corticotroph adenomas

Abstract: The presence of MMs in T2-weighted MRI is a good diagnostic tool to suggest the corticotroph subtype in an apparently nonfunctional pituitary tumour.

Cited by 44 publications

References 27 publications

Prevalence of clinically silent corticotroph macroadenomas

Prevalence of clinically silent corticotroph macroadenomas

Silent corticotroph adenomas

Clinical, Laboratory, and Treatment Profiles of Silent Corticotroph Adenomas That Have Transformed to the Functional Type: A Case Series With a Literature Review

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