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Clinical Parameters to Distinguish Silent Corticotroph Adenomas from Other Nonfunctioning Pituitary Adenomas.

 Daham Kim  ;  Cheol Ryong Ku  ;  Se Hee Park  ;  Ju Hyung Moon  ;  Eui Hyun Kim  ;  Sun Ho Kim  ;  Eun Jig Lee 
 WORLD NEUROSURGERY, Vol.115 : e464-e471, 2018 
Journal Title
Issue Date
ACTH-Secreting Pituitary Adenoma/diagnosis ; ACTH-Secreting Pituitary Adenoma/surgery* ; Adrenocorticotropic Hormone/pharmacology ; Adult ; Aged ; Cavernous Sinus/pathology ; Female ; Humans ; Hypopituitarism/surgery* ; Immunohistochemistry/methods ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Pituitary ACTH Hypersecretion/surgery* ; Pituitary Neoplasms/diagnosis ; Pituitary Neoplasms/surgery* ; Retrospective Studies
ACTH ; Corticotroph cells ; Cushing's disease ; Nonfunctioning adenoma ; Pituitary adenoma
BACKGROUND: It is difficult to distinguish silent corticotroph adenomas (SCAs) from other nonfunctioning pituitary adenomas (NFPAs) preoperatively. This study aimed to determine the preoperative clinical parameters associated with SCAs. METHODS: This was a retrospective single-center study of patients who underwent surgery for NFPAs during 2011-2016 in our tertiary hospital and who had preoperative combined pituitary function test (CPFT) and immunohistochemical staining results available. After we excluded patients with increased 24-hour urinary free cortisol to preclude overt Cushing's disease, 341 patients were finally enrolled. The medical records, including the CPFT and immunohistochemistry results, of the patients were reviewed. RESULTS: The age and tumor size were similar between patients with SCAs and other NFPAs. The SCA group had a greater proportion of women (89.2% vs. 57.6%, P < 0.001), cavernous sinus invasion (35.1% vs. 20.7%, P = 0.047), and intratumoral hemorrhage on preoperative sella magnetic resonance imaging (32.4% vs. 9.2%, P < 0.001) compared with the NFPA group. In the preoperative CPFT, the cortisol response was not significantly different between groups. However, the peak adrenocorticotropic hormone (ACTH) (67.80 ± 49.83 vs. 85.67 ± 78.97 pg/mL, P = 0.061) tended to be lower, and the ΔACTH (53.71 ± 50.14 vs. 72.67 ± 75.82 pg/mL, P = 0.046) was significantly lower in SCAs. After we excluded patients with preoperative hypopituitarism caused by mass effects, the peak ACTH (69.39 ± 39.45 vs. 119.75 ± 89.84 pg/mL, P = 0.001) and ΔACTH (58.58 ± 36.51 vs. 107.66 ± 86.05 pg/mL, P = 0.001) were significantly lower in SCAs than in other NFPAs. CONCLUSIONS: Female sex, cavernous sinus invasion, intratumoral hemorrhage on sella magnetic resonance imaging, and decreased ACTH response in the CPFT are independent indicators of SCAs.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Ku, Cheol Ryong(구철룡) ORCID logo https://orcid.org/0000-0001-8693-9630
Kim, Daham(김다함) ORCID logo https://orcid.org/0000-0003-1871-686X
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Moon, Ju Hyung(문주형)
Park, Se Hee(박세희)
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
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