Endocrine Abstracts

Patient is a 43 years old female without any known additional disease. A pituitary mass was seen in the cranial MRI taken due to the complaint of forgetfulness. Pituitary MRI of the patient revealed a ’large intrasellar mass of 3.2x3x2.3 cm, which expanded the sella and pressed the optic chiasm’. The patient didn’t describe any symptoms other than forgetfulness. She didn’t have galactorrhea, cushingoid or acromegaloid appearance. Patients laboratuary evaluation can be seen in Table 1. The patient was started on levothyroxine for central hypothyroidism and it was thought that the patient had a non-functional pituitary adenoma. In the follow-up of the patient who underwent transsphenoidal surgery, no hypopituitarism or central diabetes insipidus was detected. In the immunohistochemical and histological examination of the patient’s surgical material:’Tumor cells showed diffuse staining with ACTH. GH, PRL, TSH, FSH, LH are negative. The Ki-67 proliferation index was 3-4%.’These findings, patient’s pre-operative examinations and clinically situation were evaluated and it was determined that the patient had a ’silent corticotroph adenoma’. The patient had no complaints in the post-operative first month. Her anterior pituitary hormones were observed(Table 2). Due to the tendency of silent corticotroph adenomas to progress aggressively, pituitary MRI control was planned at the post-op 3rd month. Silent corticotroph adenomas constitutes 4.8-6.8% of all pituitary adenomas and 19% of non-functioning pituitary adenomas. It has a highly aggressive and invasive course. It often recurs after treatment and is resistant to treatment. In the studies,0.5 mg DST performed with a cut-off value of 3.0µg/dl in the screening of Cushing’s syndrome. That has been shown to have higher sensitivity and specificity than the classical 1 milligram DST. In our case, both screening tests were applied.