Endocrine Abstracts

Introduction: Silent corticotroph adenoma (SCA) is a subtype of clinically non-functioning adenoma (NFA) that shows immunohistochemistry characteristics of an adrenocorticotropic hormone secreting adenoma without biochemical or clinical manifestation of hypercortisolism. Some reports suggest a more aggressive clinical course in comparison to NFA. We analysed our experience with SCA between 2016 and 2025.

Results: There were 24 patients in the study: 12 men and 12 women. Mean age at presentation was 44 years, range 22-76. Majority presented to acute/emergency services or ophthalmology (n = 15; 62.5%). Most patients presented with visual disturbances (n = 17; 70.1%). 16 had evidence of visual field loss at presentation (66.7%) and 3 (12.5%) had cranial nerve involvement. 10 had hypopituitarism at presentation (41.7%), and post-operatively 12 (50%) were hypopituitary. All had macroadenoma, maximum dimension 10 mm or more; mean 25.2 mm (range 10 to 50 mm). All had suprasellar extension. Optic chiasm compression was evident in 17 (70.1%), a further 3 had chiasm elevation without compression (12.5%). In all, 20 (83.3%) had chiasm involvement of some description. 3 had complications – 1 each had post-operative CSF leak, bleeding and meningitis. Of the 17 with visual disturbance, 12 (70.1%) recovered vision partially or fully. Histology was consistent with SCA; all cases staining for ACTH and in more recent reports T-Pit, synaptophysin, cytokeratin and Ki-67 index were available. 4 patients had Ki-67 index between 5-8%, and of these 2 required radiotherapy due to rapid re-growth.

Conclusion and discussion: In our series, 70% of cases presented with acute visual disturbance and 41% had evidence of hypopituitarism at presentation. 83% of cases had optic chiasm involvement. 70% of patients recovered vision post-surgery. This data adds to the existing evidence base of this distinct subtype and underscores the need for prospective studies looking at their long-term clinical course and prognosis.