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Clinical profiles of silent corticotroph adenomas compared with silent gonadotroph adenomas after adopting the 2017 WHO pituitary classification system

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Abstract

Purpose

Silent corticotroph adenomas (SCAs) can be redefined according to the 2017 World Health Organization pituitary classification system with the introduction of T‑PIT, a transcription factor. We studied the clinical features of these redefined SCAs.

Methods

We compared 112 patients with SCAs and 198 patients with silent gonadotroph adenomas (SGAs) who underwent surgery from January 2019 to May 2020.

Results

The prevalence of SCAs increased from 21.3 to 30.2% under the new classification rules. T-PIT-positive, adrenocorticotropic hormone-negative SCAs and T-PIT-positive, adrenocorticotropic hormone-positive SCAs exhibited similar clinical features. SCAs exhibited significant female preponderance (90.2% vs. 29.8%, P < 0.0001); more frequent invasion (36.6% vs. 7.6%, P < 0.0001), especially multiple-site invasion (P < 0.0001); and marked cystic changes on imaging compared with SGAs (54.5% vs. 19.2%, P < 0.0001). SCAs had a softer tumor consistency (89.2% vs. 61.1%, P < 0.0001). Gross total resection was achieved in 66.1% of SCAs and 66.2% of SGAs (P > 0.9999). The overall recurrence/progression rates of SCAs and SGAs were 9.8% and 6.6% at 14.1 and 13.5 months of follow-up, respectively (P = 0.3765). The proportion of patients with more than two recurrences requiring multiple surgeries and radiation was similar between SCAs and SGAs (7.1% vs. 3.0%, P = 0.1514). However, multiple recurrences of SCAs affected younger patients than SGAs (39.0 vs. 53.5 years, P = 0.0433).

Conclusions

The prevalence of SCAs increased with the introduction of T-PIT. SCAs and SGAs exhibited comparable size and recurrence/progression rates, but SCAs showed increased invasion and more marked cystic change. Aggressive SCAs tended to affect younger patients. Close long-term monitoring for SCA recurrence/progression is required.

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Acknowledgements

We thank the medical staff for providing clinical experience.

Funding

This work was supported by the National Key Research and Development Program of China (2018YFA0108600), Natural Science Foundation of Beijing Municipality (7182134), CAMS Initiative for Innovative Medicine (2016–I2M–1–017), and Beijing Nova Program (Z181100006218003).

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Authors and Affiliations

  1. Department of Neurosurgery, Pituitary Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Shenzhong Jiang, Jianyu Zhu, Ming Feng, Yong Yao, Kan Deng, Bing Xing, Wei Lian, Renzhi Wang & Xinjie Bao

Authors
  1. Shenzhong Jiang
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  2. Jianyu Zhu
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  3. Ming Feng
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  4. Yong Yao
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  5. Kan Deng
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  6. Bing Xing
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  7. Wei Lian
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  8. Renzhi Wang
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  9. Xinjie Bao
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Contributions

All authors contributed to the study design, data acquisition or analysis, data interpretation, drafting of the article, and final approval of the version to be published. SJ collected the data and interpreted the findings. JZ, MF, YY, KD, BX, and WL analyzed the data and revised the manuscript for important intellectual content. RW and XB take final responsibility for this manuscript.

Corresponding authors

Correspondence to Renzhi Wang or Xinjie Bao.

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Conflict of interest

No competing financial interests exist.

Ethical approval

This study was approved by the Ethics Committee of Peking Union Medical College Hospital. Written informed consent was obtained from all the patients.

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Jiang, S., Zhu, J., Feng, M. et al. Clinical profiles of silent corticotroph adenomas compared with silent gonadotroph adenomas after adopting the 2017 WHO pituitary classification system. Pituitary 24, 564–573 (2021). https://doi.org/10.1007/s11102-021-01133-8

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  • DOI: https://doi.org/10.1007/s11102-021-01133-8

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