Hormones and Cancer

, Volume 1, Issue 2, pp 80–92

Silent Corticogonadotroph Adenomas: Clinical and Cellular Characteristics and Long-Term Outcomes

  • Odelia Cooper
  • Anat Ben-Shlomo
  • Vivien Bonert
  • Serguei Bannykh
  • James Mirocha
  • Shlomo Melmed
Article

DOI: 10.1007/s12672-010-0014-x

Cite this article as:
Cooper, O., Ben-Shlomo, A., Bonert, V. et al. HORM CANC (2010) 1: 80. doi:10.1007/s12672-010-0014-x

Abstract

Silent corticotrophins adenomas (SCAs) are clinically silent and non-secreting but immunostain positively for ACTH. We hypothesize that SCAs comprise both corticotroph and gonadotroph characteristics. Cohort analysis from 1994–2008 with follow-up time ranging from 1–15 years in a tertiary referral center. We compared preoperative and postoperative clinical results and tumor cytogenesis in 25 SCAs and 84 nonfunctioning adenomas in 109 consecutive patients diagnosed pre-operatively with nonfunctioning pituitary adenomas. Clinical outcomes were radiologic and hormonal measures. Pathologic outcomes were expression of relevant pituitary hormones, tissue-specific transcription factors, and electron microscopy features. Preoperative SCA presentation was similar to that observed for nonfunctioning adenomas. However, SCAs recurred postoperatively at a median of 3 years vs. 8 years for nonfunctioning adenomas (p < 0.0001). Fifty-four percent of patients with SCAs had new onset postoperative hypopituitarism vs. 17% of nonfunctioning adenomas (p < 0.025). SCAs (n = 18) were immunopositive for ACTH, cytoplasmic and nuclear SF-1, NeuroD1, DAX-1, and alpha-gonadotropin subunit, but Tpit negative, and co-expression of tumor ACTH with either SF-1 or LH was detected. In contrast, functional corticotroph adenomas (n = 11) were immunopositive for ACTH, nuclear SF-1, NeuroD1, and Tpit, but negative for DAX-1, a gonadotroph cell transcription factor. Gonadotroph adenomas (n = 23) were immunonegative for ACTH and Tpit but positive for nuclear SF-1, NeuroD1, and DAX-1. SCA electron microscopy demonstrated ultrastructural features consistent with corticotroph and gonadotroph cells. As SCAs exhibit features consistent with both corticotroph and gonadotroph cytologic origin, we propose a pathologic and clinically distinct classification of SCAs as silent corticogonadotroph adenomas.

Keywords

Pituitary adenoma Corticotroph adenoma Gonadotroph adenoma Nonfunctioning adenoma 

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Odelia Cooper
    • 1
  • Anat Ben-Shlomo
    • 1
  • Vivien Bonert
    • 1
  • Serguei Bannykh
    • 2
  • James Mirocha
    • 3
  • Shlomo Melmed
    • 1
  1. 1.Pituitary CenterCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of PathologyCedars-Sinai Medical CenterLos AngelesUSA
  3. 3.Biostatistics Research InstitituteCedars-Sinai Medical CenterLos AngelesUSA

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