Clinical profiles of silent corticotroph adenomas compared with silent gonadotroph adenomas after adopting the 2017 WHO pituitary classification system

Jiang, Shimin; Zhu, Jianyu; Feng, Ming; Yao, Yong; Deng, Kan; Xing, Bing; Lian, Wei; Wang, Renzhi; Bao, Xinjie

doi:10.1007/s11102-021-01133-8

Cited by 19 publications

(13 citation statements)

References 24 publications

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“…Notably, the pathological type of the tumor was correlated with the “Mosaic sign”, that is, corticotroph tumors (Including SCAs) were more prone to the “Mosaic sign”, suggesting soft tumor consistency, consistent with what has been reported in the literature ( 31 ). Microcyst patterns on T2-WI have been considered radiological features of SCAs in several studies ( 32 , 33 ).…”

Section: Discussionsupporting

confidence: 83%

Application of “mosiac sign” on T2-WI in predicting the consistency of pituitary neuroendocrine tumors

Nie

Zhao

et al. 2022

Front. Surg.

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PurposeTumor consistency is important for pituitary neuroendocrine tumors (PitNETs) resection to improve surgical outcomes. In this study, we evaluated the T2-WI of PitNETs and defined a specific T2-WI signaling manifestation, the “Mosaic sign,” to predict tumor consistency and resection of PitNETs.DesignA retrospective review of MRI and tumor histology of 137 consecutive patients who underwent endoscopic endonasal resection for PitNETs was performed.MethodsThe “Mosaic sign” was defined by the ratio of the tumor itself T2-WI signals, and characterized by multiple intratumor hyperintense dots. The degree of tumor resection was an assessment by postoperative MRI examination. The presence of the “Mosaic sign” was compared with patients' basic information, tumor consistency, tumor pathological staining, and surgical result. To determine whether the presence or absence of “Mosaic sign” could predict tumor consistency and guide surgical resection of tumors.ResultsStatistical analysis showed that the consistency of the tumor and the degree of resection were correlated with the “Mosaic sign”. In the 137 cases of T2-WI, 43 had “Mosaic sign”, 39 cases had soft tumor consistency, and 4 were classified as fibrous, of which 42 were completely resected and 1 was subtotal resected. Of the 94 patients without “Mosaic sign”, the consistency of tumor of 54 cases were classified as soft, the remaining 40 cases were fibrous, 80 cases were completely resected, and 14 cases were subtotal resected. Postoperative cerebrospinal fluid leakage occurred in 1 patient. The number of corticotroph adenomas in the group of “Mosaic sign” was higher, with the statistical difference between the two groups (P = 0.0343).ConclusionsThe presence of the “Mosaic sign” in T2-WI may provide preoperative information for pituitary adenomas consistency and effectively guide surgical approaches.

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Section: Discussionsupporting

confidence: 83%

Application of “mosiac sign” on T2-WI in predicting the consistency of pituitary neuroendocrine tumors

Nie

Zhao

et al. 2022

Front. Surg.

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“…In this setting of an individual case report, we cannot prove the causal effect of AAS abuse or exclude a potential role of other factors such as the histologic type of the tumor (32). A certain degree of subclinical hypercortisolism before surgery, contributing to a prothrombotic state, cannot be formally excluded, but seems very unlikely based on recent data from relatively large series of clinically silent corticotroph macroadenomas (33). Given that AAS for non-medical purposes are most often bought over the counter, we cannot exclude the possibility that the AAS preparation in this case could have contained other stimulant substances exerting an additive effect to the prothrombotic state and contributing to the PA.…”

Section: Discussionmentioning

confidence: 92%

Potential Association Between Anabolic Androgenic Steroid Abuse and Pituitary Apoplexy: A Case Report

et al. 2022

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IntroductionPituitary apoplexy (PA) is a rare, and potentially life-threatening condition, caused by hemorrhage or infarction into the pituitary gland with a rapid expansion of the contents of the sella turcica, associated with sudden intense headache, neurological and endocrinological deterioration. The identification of risk factors is crucial for prevention and optimal management. Herein we report a case of PA occurring 1 month after the initiation of anabolic androgenic steroid abuse for bodybuilding.Case ReportA 40-year-old male patient presents with abrupt onset headache associated with left partial third cranial nerve palsy. The MRI shows a sellar lesion involving left cavernous sinus with a heterogenous anterior aspect of the lesion with hemorrhagic zones in favor of PA. Endocrine work-up shows high testosterone level in patient who was using exogenous testosterone without a medical prescription for a month.ConclusionWe report a case of PA of a pituitary neuroendocrine tumor occurring shortly after AAS. The association between PA and AAS should be considered as a potential risk.

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“…In our case, dynamic testing was compatible with an ACTH-producing pituitary adenoma, as CRH stimulation induced a significant increase in ACTH and cortisol. We also show for the first time that such ectopic pituitary adenomas also express T-Pit, a transcription factor specifically expressed in pituitary cells that acquire a corticotroph phenotype [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Ectopic sphenoidal ACTH-secreting adenoma revealed by 11C Methionine PET scan: case report

et al. 2023

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Background Ectopic ACTH pituitary adenomas (EAPA), located outside the sella turcica and deriving from cellular remnants of Rathke’s pouch are a very rare cause of Cushing’s syndrome (CS). The diagnosis is often difficult and delayed, even after comprehensive work-up. To our knowledge, we report for the first time an ectopic corticotroph tumor of the posterior wall of the sphenoid sinus, leading to false positive results of bilateral inferior petrosal sinus sampling (BIPPS) and which was finally localized by a co-registered11 C Methionine PET/MR imaging. Case presentation A 48-year-old woman was referred for a high clinical suspicion of ACTH-dependent CS. Biological testing comprising low dose dexamethasone suppression and CRH stimulation tests were indicative of pituitary Cushing’s disease, but comprehensive pituitary MRI did not reveal any pituitary adenoma. BIPSS confirmed however a central origin of ACTH secretion (central-to-peripheral ACTH ratio > 100) and revealed a significant right-to-left gradient (6.2), leading to a first right-sided exploratory hypophysectomy, that did not cure the patient. BIPSS images were reviewed and revealed preferential drainage of the left pituitary to the right petrosal sinus, leading us to a left sided exploratory hypophysectomy, which was again unsuccessful. A11 C Methionine PET/MRI was performed and revealed a hypermetabolic lesion adjacent to the posterior wall of the sphenoidal sinus. After surgical resection, this polypoid mass was identified as an ectopic ATCH-secreting pituitary adenoma expressing ACTH and T-Pit and complete remission of hypercortisolism was observed. Conclusions In conclusion, we report a case of ACTH-dependent Cushing’s syndrome, caused by an ectopic corticotroph adenoma located in the sphenoidal sinus, which perfectly mimicked the biological features of a classical pituitary ACTH adenoma on a comprehensive hormonal evaluation including BIPPS, and the features of a benign naso-sinusal polyp at MRI. We report for the first time a key role of11 C Methionine PET co-registered to high resolution MRI for localizing ectopic adenomas, efficiently guiding surgical removal and leading to complete remission of hypercortisolism.

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Clinical profiles of silent corticotroph adenomas compared with silent gonadotroph adenomas after adopting the 2017 WHO pituitary classification system

Cited by 19 publications

References 24 publications

Application of “mosiac sign” on T2-WI in predicting the consistency of pituitary neuroendocrine tumors

Application of “mosiac sign” on T2-WI in predicting the consistency of pituitary neuroendocrine tumors

Potential Association Between Anabolic Androgenic Steroid Abuse and Pituitary Apoplexy: A Case Report

Ectopic sphenoidal ACTH-secreting adenoma revealed by 11C Methionine PET scan: case report

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