Silent or Subclinical Corticotroph Pituitary Macroadenoma Transforming Into Cushing Disease

Melcescu, Eugen; Gannon, Anthony W.; Parent, Andrew D.; Fratkin, Jonathan; Nicholas, W. Channing; Koch, Christian A.; Galhom, Ayman

doi:10.1227/neu.0b013e3182750850

Cited by 26 publications

(11 citation statements)

References 5 publications

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“…Rarely, initially silent corticotroph tumours may evolve to secrete ACTH after many years of follow-up, and this transformation may also herald more aggressive tumour behaviour (42,43,44,45). Silent subtype III or plurihormonal silent tumours (40) also may exhibit a more aggressive clinical course compared with silent gonadotroph tumours (46).…”

Section: Reasoningmentioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

Raverot

Burman

McCormack

et al. 2018

European Journal of Endocrinology

477

583

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Background: Pituitary tumours are common and easily treated by surgery or medical treatment in most cases. However, a small subset of pituitary tumours does not respond to standard medical treatment and presents with multiple local recurrences (aggressive pituitary tumours) and in rare occasion with metastases (pituitary carcinoma). The present European Society of Endocrinology (ESE) guideline aims to provide clinical guidance on diagnosis, treatment and follow-up in aggressive pituitary tumours and carcinomas. Methods: We decided upfront, while acknowledging that literature on aggressive pituitary tumours and carcinomas is scarce, to systematically review the literature according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The review focused primarily on first-and second-line treatment in aggressive pituitary tumours and carcinomas. We included 14 single-arm cohort studies (total number of patients = 116) most on temozolomide treatment (n = 11 studies, total number of patients = 106). A positive treatment effect was seen in 47% (95% CI: 36-58%) of temozolomide treated. Data from the recently performed ESE survey on aggressive pituitary tumours and carcinomas (165 patients) were also used as backbone for the guideline. In patients responding to first-line temozolomide, we suggest continuing treatment for at least 6 months in total. Furthermore, the guideline offers recommendations for patients who recurred after temozolomide treatment, for those who did not respond to temozolomide and for patients with systemic metastasis.

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Section: Reasoningmentioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

Raverot

Burman

McCormack

et al. 2018

European Journal of Endocrinology

477

583

View full text Add to dashboard Cite

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“…A number of individual cases of SCAs were reported to transform to symptomatic functioning Cushing Disease, notably after receiving radiotherapy [3,4,6,14,32,60,64]. However, in large series of SCAs, 2 groups each reported only 1 case transforming to biochemical Cushing disease but without clinical stigmata [19,61].…”

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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“…Данный тип опухолей отличается также более агрессивным те-чением заболевания в послеоперационном периоде, что связано с развитием гипопитуитаризма (и/или но-выми проявлениями недостаточности тропных функ-ций) в более чем половине случаев [21,22]. Описаны клинические случаи с трансформацией кортикотропи-ном из «немых» в активные формы с развитием мани-фестной болезни Иценко-Кушинга [23,24].…”

Section: «немые» кортикотропиномыunclassified

“…Для молодых пациентов с молча-щими кортикотропиномами характерен более агрес-сивный рост образований, большая частота рецидива заболеваний, возможность трансформации опухоли в функционально-активное образование [23,24].…”

Section: клинический случай №2unclassified

Silent pituitary adenomas: review and clinical cases

et al. 2015

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Г ормонально-неактивные аденомы гипофиза представляют собой морфологически гетероген-ную группу и подразделяются на «немые» аде-номы, обладающие иммунореактивностью к тропным гормонам и схожим строением с типичными адено-цитами, но не приводящие к развитию клинических признаков гормональной гиперсекреции, и опухоли, не имеющие специфических маркеров и сходства с аденогипофизарными клетками. К первой группе относятся «немые» гонадо-, кортико-, сомато-, тиро- Гормонально-неактивные аденомы гипофиза представляют собой морфологически гетерогенную группу и подразделяются на «немые» аденомы, обладающие иммунореактивностью к тропным гормонам и схожим строением с типичными адено-цитами, но не приводящие к развитию клинических признаков гормональной гиперсекреции («немые» гонадо-, кортико-, сомато-, тиро-и маммотропиномы), и опухоли, не имеющие специфических маркеров и сходства с аденогипофизарными клетками (ноль-клеточные опухоли и онкоцитомы). Согласно проводимым исследованиям, все типы «немых» аденом имеют различную биологическую активность, секреторный потенциал и исходы в послеоперационном периоде. Данная серия клинических случаев демонстрирует более «агрессивное» течение заболевания, высокий риск рецидива при «немых» кор-тико-и соматотропиномах гипофиза. Активное выявление «немых» кортико-и соматотропином при проведении иммуно-гистохимического анализа не только позволяет выявить пациентов из группы высокого риска рецидива заболевания, но и выработать оптимальную тактику лечения и дальнейшего наблюдения, определить показания и оценить целесообраз-ность медикаментозной и лучевой терапии после проведенного нейрохирургического вмешательства. Silent, or clinically nonfunctioning adenomas, are morphologically heterogeneous group, characterized by positive immunoreactivity for one or more hormones classically secreted by normal pituitary cells but without clinical expression. Although in some occasions enhanced or changed secretory activity can develop over time. According to immunoreactivity they are divided into "silent" gonado-, cortico-, somato -, mammo -and thyrotropinomas, oncocytomas, «null-cell» tumors. All types of "silent" adenomas have different biological activity, secretory capacity and outcomes in the postoperative period. This series of clinical cases shows more «aggressiveness», a higher risk of relapse for "silent" cortico-and somatotropinomas. Immunohistochemical analysis of residual tissue can be used to identify patients with high risk of recurrence, and to develop optimal treatment and follow-up.

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Silent or Subclinical Corticotroph Pituitary Macroadenoma Transforming Into Cushing Disease

Cited by 26 publications

References 5 publications

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

Silent corticotroph adenomas

Silent pituitary adenomas: review and clinical cases

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