Silent corticotroph adenomas: Further clinical and pathological observations

Lopez, John A.; Kleinschmidt‐DeMasters, Bette K.; Sze, Chun I.; Woodmansee, Whitney W.; Lillehei, Kevin O.

doi:10.1016/j.humpath.2004.04.016

Cited by 53 publications

(67 citation statements)

References 19 publications

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“…They account for 1.1-6% of surgically removed pituitary adenomas (2-5) and 17-22% of ACTHimmunoreactive tumours (4,6). The sex predominance, as reported in neurosurgical series, remains unclear.…”

Section: Adenomas Corticotróficos Silenciososmentioning

confidence: 99%

“…By contrast, the type 2 adenoma is generally chromophobic or weakly basophilic with scattered PAS-staining and reveals only patchy or faint ACTH-positivity by immunohistochemistry. Ultrastructurally, type 2 SCAs contain scattered, typically "tear-drop"-shaped neurosecretory granules, 200-400 nm in diameter (smaller than those of type 1 SCAs) and of variable electron density (6,9). Furthermore, type 2 SCAs lack abundant intermediate filaments in their cytoplasm compared with type 1 SCAs and the classical densely granulated Cushing's adenoma.…”

Section: Pathology and Pathogenesismentioning

confidence: 99%

“…However, in a study of 12 cases, scant co-expression of prolactin was found in 6/8 type 1 and 2/4 type 2 SCAs (6); an earlier study found some prolactin positivity in 2/23 cases (8). Interestingly, a few patients harbouring silent-corticotroph and prolactin-producing "double-adenomas", likely clonally distinct, have been reported (6). This, together with the presence of scattered prolactin-producing cells within a proportion of typical SCAs may suggest a potential pathogenetic link (6,8) between SCAs and neoplastic transformation of prolactin-producing cells.…”

Section: Pathology and Pathogenesismentioning

confidence: 99%

“…Interestingly, a few patients harbouring silent-corticotroph and prolactin-producing "double-adenomas", likely clonally distinct, have been reported (6). This, together with the presence of scattered prolactin-producing cells within a proportion of typical SCAs may suggest a potential pathogenetic link (6,8) between SCAs and neoplastic transformation of prolactin-producing cells. A paracrine dopamine antagonistic effect of betaendorphin, a proopiomelanocortin (POMC) derivative produced by SCAs, on lactotroph cells may play a role in this process.…”

Section: Pathology and Pathogenesismentioning

confidence: 99%

“…This may appear on imaging as cystic change, suggesting in some instances an alternative preoperative diagnosis of craniopharyngioma (6).…”

Section: Pathology and Pathogenesismentioning

confidence: 99%

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Silent corticotroph adenomas

Karavitaki

Ansorge

Wass

2007

Arq Bras Endocrinol Metab

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Silent corticotroph pituitary adenomas (SCA) are defined as pituitary adenomas showing positive staining for adrenocorticotrophic hormone in immunohistochemical studies, but not associated with perioperative clinical or laboratory features of hypercortisolaemia. They account for 1.1-6% of surgically removed pituitary adenomas. Currently, two distinct pathologic subtypes of SCA are recognised. Their pathogenesis remains unclear. They present with local mass effects (headache, visual deterioration, cranial nerve palsies, endocrine dysfunction). The lack of manifestations of cortisol excess has not been conclusively explained. In surgical series, most tumours are macroadenomas with suprasellar extension present in 87-100% of the cases; this is in contrast to Cushing's disease, which is mostly attributed to microadenomas. Surgery remains the main therapeutic approach. Attempts to identify predictors of recurrence have not been successful. Management and follow-up protocols should be planned taking into account their potential aggressive behaviour, particularly upon recurrence. The development of florid pituitary Cushing's syndrome and local recurrence followed by metastatic disease (occasionally outside the central nervous system) have been rarely reported. Adenomas corticotróficos silenciosos (ACS) são definidos como adenomas hipofisários que apresentam coloração positiva para o hormônio adrenocorticotrófico em estudos imuno-histoquímicos, mas não são associados com achados clínicos ou laboratoriais peri-operatórios de hipercortisolemia. São responsáveis por 1,1-6% dos adenomas hipofisários removidos cirurgicamente. Atualmente, dois subtipos patológicos distintos de ACS são reconhecidos, mas sua patogênese permanece obscura. Eles se apresentam com efeitos de massa local (cefaléia, deterioração visual, paralisia de nervos cranianos, disfunção endócrina). A ausência de manifestações de excesso de cortisol não é suficientemente explicada. Em séries cirúrgicas, a maioria dos tumores são macroadenomas com extensão suprasselar, presente em 87-100% dos casos, em contraste com a doença de Cushing, que é principalmente atribuída a microadenomas. A cirurgia continua a principal ação terapêutica. A tentativa de se identificar preditores de recorrência tem sido mal sucedida. Protocolos de manejo e acompanhamento devem ser planejados levando-se em consideração o seu comportamento potencialmente agressivo, particularmente na recorrência. Raramente tem sido reportado o desenvolvimento de síndrome de Cushing hipofisária florida e recorrência local, seguida de doença metastática (ocasionalmente fora do sistema nervoso central).

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Section: Adenomas Corticotróficos Silenciososmentioning

confidence: 99%

Section: Pathology and Pathogenesismentioning

confidence: 99%

Section: Pathology and Pathogenesismentioning

confidence: 99%

Section: Pathology and Pathogenesismentioning

confidence: 99%

“…This may appear on imaging as cystic change, suggesting in some instances an alternative preoperative diagnosis of craniopharyngioma (6).…”

Section: Pathology and Pathogenesismentioning

confidence: 99%

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Silent corticotroph adenomas

Karavitaki

Ansorge

Wass

2007

Arq Bras Endocrinol Metab

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Neoplasms of the Endocrine Glands: Pituitary Neoplasms

Gandhi

Post

2017

Holland‐Frei Cancer Medicine

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Overview Pituitary neoplasms represent a phenotypically and pathologically diverse family of tumors. Treatment and classification are both patient and tumor specific as symptoms may derive from abnormal hormone production, compression of adjacent nervous system structures, and, in rare cases, metastases. Transsphenoidal surgery represents a common and well‐tolerated treatment for most pituitary adenomas; however, advances in radiation and chemotherapy have increased treatment options, enhancing treatment efficacy, and eligibility.

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Silent Corticotroph Adenomas

Kaushal

Shalet

2011

Cushing's Disease

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Silent corticotroph adenomas: Further clinical and pathological observations

Cited by 53 publications

References 19 publications

Silent corticotroph adenomas

Silent corticotroph adenomas

Neoplasms of the Endocrine Glands: Pituitary Neoplasms

Silent Corticotroph Adenomas

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