, Volume 20, Issue 4, pp 471–476 | Cite as

Perioperative hypothalamic pituitary adrenal function in patients with silent corticotroph adenomas

  • Abdelle F. Cheres
  • Nadine ElAsmar
  • Aman Rajpal
  • Warren R. Selman
  • Baha M. ArafahEmail author



Silent corticotroph adenomas (SCAs) are characterized by strong ACTH immunostaining without clinical manifestations of hypercortisolism. Patients with SCAs often present with mechanical symptoms related to tumor growth. This study investigates the hypothalamic pituitary adrenal axis (HPA) characteristics after adenomectomy in patients with SCAs.


Biochemical parameters of HPA function were monitored frequently after surgical resection of non-functioning macroadenomas. Levels of ACTH, cortisol, DHEA and DHEA-S were measured frequently for 48 h after adenomectomy. HPA data of patients with SCAs (n = 38) were compared to others (Controls) with non-secreting, ACTH-negative immunostaining adenomas of similar age and gender distribution (n = 182) who had adenomectomy.


Plasma ACTH increased (P < 0.0001) equally in patients with SCA and controls reaching a peak at 3 h (238 ± 123 vs. 233 ± 96 ng/L, respectively) after extubation declining thereafter to baseline values 24–36 h. Similarly, serum cortisol levels increased (P < 0.0001) equally in both groups reaching a maximum at 7 h (36.8 ± 13.9 vs. 39.3 ± 13.3 ug/dL). Serum DHEA also increased (P < 0.001) equally in both groups in parallel to the rise in serum cortisol. Serum DHEA-S levels similarly increased (P < 0.001) from their respective baseline (105.9 ± 67.5 and 106.5 ± 58.7 ug/dL) reaching their peak (154.5 ± 69.5 and 153.5 ± 68.6 ug/dL; respectively) at 15 h after extubation. None of the patients acquired any hormone deficits.


Under the maximal stimulation of the peri-operative stress, HPA function in patients with SCA behaved in an identical manner to others with ACTH-negative macroadenomas. Thus, despite the strong ACTH-positive immunostaining of these tumors, SCAs are truly non- functional.


HPA function Silent corticotroph adenomas Non-secreting adenomas Pituitary surgery 



This work was funded by local/departmental grant.

Compliance with ethical standards

Conflict of interest

The authors declares that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Abdelle F. Cheres
    • 1
  • Nadine ElAsmar
    • 1
  • Aman Rajpal
    • 1
  • Warren R. Selman
    • 2
  • Baha M. Arafah
    • 1
    Email author
  1. 1.Division of Clinical and Molecular EndocrinologyUniversity Hospitals Cleveland Medical Center and Case Western Reserve UniversityClevelandUSA
  2. 2.Department of Neurological SurgeryUniversity Hospitals Cleveland Medical Center and Case Western Reserve UniversityClevelandUSA

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