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Clinical Parameters of Silent Corticotroph Adenomas With Positive and Negative Adrenocorticotropic Hormone Immunostaining: A Large Retrospective Single-Center Study of 105 Cases.
- Source :
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Frontiers in endocrinology [Front Endocrinol (Lausanne)] 2021 Jan 18; Vol. 11, pp. 608691. Date of Electronic Publication: 2021 Jan 18 (Print Publication: 2020). - Publication Year :
- 2021
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Abstract
- Purpose: To investigate the different clinical characteristics of silent corticotroph adenomas (SCAs) with positive and negative adrenocorticotropic hormone (ACTH) immunostaining, and to explore the value of pituitary-restricted transcription factor (Tpit) immunostaining for diagnosing SCAs.<br />Methods: The clinical materials of patients with SCAs who had a typical pathological feature with positive Tpit immunostaining and positive/negative ACTH immunostaining, and without clinical features and biochemical evidence for Cushing's Syndrome in our center from April 2018 to March 2019 were analyzed retrospectively. The differences in clinical characteristics and surgical results between ACTH-positive and -negative SCAs were explored.<br />Results: A total of one hundred and five patients (94.3% female) with SCAs were included. There were 66 SCAs with ACTH-negative (66/105, 62.9%), and 39 SCAs with ACTH-positive (39/105, 37.1%). Cases with ACTH-negative SCAs were more likely to have lower ACTH levels (27.5 ± 24.0 vs. 54.4 ± 58.6, P = 0.011), more multiple microcysts (81.8% vs. 61.5%, P = 0.022) and lower levels of Ki-67 expression (low expression rate 90.9% vs. 74.4%, P = 0.023). No statistical significant differences were observed between patients with ACTH-positive and -negative SCAs regarding gender (97.0% vs. 89.7%, P = 0.192), age (50.3 ± 10.3 vs. 49.0 ± 11.2, P = 0.543), surgical history (16.7% vs. 23.1%, P = 0.419), suprasellar extension (66.7% vs. 74.4%, P = 0.408), sphenoid sinus extension (51.5% vs. 56.4%, P = 0.627), cavernous sinus invasion (75.8% vs. 66.7%, P = 0.314), large cyst on Magnetic Resonance Imaging (MRI) (47.0% vs. 61.5%, P = 0.149), or gross total resection rate (42.4% vs. 51.3%, P = 0.379).<br />Conclusions: ACTH-negative SCAs were observed to be more clinically silent and more likely to demonstrate multiple microcysts on MRI. The prevalence of SCAs, especially ACTH-negative SCAs, proved to be substantially underestimated and thus they should be given enough attention in consideration of the high aggressiveness of this subtype of refractory pituitary adenoma (PA).<br />Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.<br /> (Copyright © 2021 Zhang, Shou, Chen, Qiao, He, Chen, Shen, Li, Zhao, Zhang, Li, Ye and Wang.)
- Subjects :
- ACTH-Secreting Pituitary Adenoma pathology
ACTH-Secreting Pituitary Adenoma surgery
Adenoma pathology
Adenoma surgery
Adolescent
Adult
Aged
Biomarkers analysis
Cushing Syndrome diagnosis
Cushing Syndrome pathology
Cushing Syndrome surgery
Female
Homeodomain Proteins analysis
Humans
Immunohistochemistry
Ki-67 Antigen
Magnetic Resonance Imaging
Male
Middle Aged
Retrospective Studies
T-Box Domain Proteins analysis
Treatment Outcome
Young Adult
ACTH-Secreting Pituitary Adenoma diagnosis
Adenoma diagnosis
Adrenocorticotropic Hormone metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1664-2392
- Volume :
- 11
- Database :
- MEDLINE
- Journal :
- Frontiers in endocrinology
- Publication Type :
- Academic Journal
- Accession number :
- 33584540
- Full Text :
- https://doi.org/10.3389/fendo.2020.608691