Silent pituitary macroadenomas - clinical behavior and prognosis

Ines Manique; Sara Amaral; Ana Palha; Luisa Cortez; Luis Cerqueira; Amets Sagarribay; Jose Silva-Nunes

doi:10.1530/endoabs.90.EP703

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Endocrine Abstracts (2023) 90 EP703 | DOI: 10.1530/endoabs.90.EP703

ECE2023 Eposter Presentations Pituitary and Neuroendocrinology (234 abstracts)

Silent pituitary macroadenomas – clinical behavior and prognosis

Inês Manique ¹ , Sara Amaral ¹ , Ana Palha ¹ , Luísa Cortez ¹ , Luís Cerqueira ² , Amets Sagarribay ³ & José Silva-Nunes ¹

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¹Centro Hospitalar Universitário de Lisboa Central, Endocrinology, Lisboa, Portugal; ²Centro Hospitalar Universitário de Lisboa Central, Neuroradiology, Lisboa, Portugal; ³Centro Hospitalar Universitário Lisboa Central, Neurosurgery, Lisboa, Portugal

Introduction: A third of pituitary adenomas are non-functioning. Classification depends on adenohypophyseal hormones expression and transcription factors.

Aim: Characterize silent pituitary macroadenomas cases regarding their clinical data, treatment, histopathology and prognosis.

Methods: We revised clinical process of patients followed in CHULC. Cases with non-access to clinical follow-up registries or exams were excluded.

Results: Sixty-five patients (69.2% male), diagnosed at 53.6±14.3 years-old, followed during 6.6±4.4 years. 58.5% (n=38) were diagnosed in the context of tumoral mass effect; 21.5% (n=14) hypopituitarism; 9.2% (n=6) pituitary apoplexy and 10,8% (n=7) as an incidentaloma. 33,8% (n=22) had visual fields alterations with bitemporal hemianopsia being the commonest (9%; n=16). The characteristics of the different cases are summarized in Table 1 .

Table 1 Silent pituitary adenomas characteristics
	Gonadotropinomas
	FSH/FSH +LH	FSH-/LH-SF1+	ACTH	TSH	PRL	FSH+LH+TSH	FSH+ACTH+PRL	GH+TSH	PRL+GH
Number	44 (67,7%)	5 (7,7%)	6 (9,2%)	2 (3,1%)	1 (1,5%)	4 (6,2%)	1 (1,5%)	1 (1,5%)	1 (1,5%)
Dimension (mm)	29,7±7,1	30,7±12,8	28,5±6,9	27,5±6,4	23	34,2±6,8	41	24	37
Extension
suprasellar	43	2	6	2	1	4	1	1	1
infrasellar	16	1	2	0	0	1	1	0	0
parasellar	29	1	6	0	1	4	1	1	1
Knosp
0	1	1	0	0	0	0	0	0	0
1	7	1	1	1	0	1	1	1	0
2	22	1	4	1	1	0	0	0	0
3A	11	2	0	0	0	2	0	0	1
3B	1	0	1	0	0	1	0	0	0
4	2	0	0	0	0	0	0	0	0
Optic chiasm contact/compression	41	4	6	2	1	4	1	1	1
Sphenoid sinus invasion	5	0	0	1	0	0	0	0	0
Number of Surgeries	1,22±0,6	1	2,3±1,7	2	1	1,25±0,5	2	1	1
Ki 67	<3% (n=42) 3–10% (n=2)	<3% (n=5)	<3% (n=4) 3–10% (n=2)¹	<3% (n=2)	<3% (n=1)	<3% (n=4)	<3% (n=1)	<3% (n=1)	3–10% (n=1)
Cabergoline	5	2	0	0	1	0	0	0	1
Radiotheraoy	1	0	2	1	0	1	0	0	0
*In a silent corticotropinoma operated 5 times, Ki-67 increased in the successive histopathologic evaluations reaching 25%.

Conclusion: As expected, silent gonadotropinomas were the most prevalent and all the hormone negative adenomas expressed SF1. Although most of silent adenomas have a good prognosis, silent corticotropinomas seems to be more challenging to treat. Histopathology is decisive to predict the prognosis.