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Clinical Significance of Radical Surgery in the Treatment of Silent Corticotroph Adenoma

Journal of Korean Neurosurgical Society 2019년 62권 1호 p.114 ~ 122
김준형, Yoon Seon-Jin, 문주형, 구철룡, 김세훈, 이은직, 김선호, 김의현,
소속 상세정보
김준형 ( Kim Jun-Hyung ) - Yonsei University College of Medicine Department of Neurosurgery
 ( Yoon Seon-Jin ) - Yonsei University College of Medicine Department of Neurosurgery
문주형 ( Moon Ju-Hyung ) - Yonsei University College of Medicine Department of Neurosurgery
구철룡 ( Ku Cheol-Ryong ) - Yonsei University College of Medicine Department of Internal Medicine
김세훈 ( Kim Se-Hoon ) - Yonsei University College of Medicine Department of Pathology
이은직 ( Lee Eun-Jig ) - Yonsei University College of Medicine Department of Internal Medicine
김선호 ( Kim Sun-Ho ) - Yonsei University College of Medicine Department of Neurosurgery
김의현 ( Kim Eui-Hyun ) - Yonsei University College of Medicine Department of Neurosurgery

Abstract


Objective: Silent corticotroph adenomas (SCA) are endocrine-inactive pituitary adenomas with positive immunohistochemistry staining for adrenocorticotropic hormone (ACTH). We investigated whether SCA-associated clinical profiles were more aggressive than hormonally negative adenomas (HNA).

Methods: Among 627 patients with pathologically proven endocrine-inactive pituitary adenomas between 2004 and 2013, positive immunohistochemistry revealed 55 SCAs and 411 HNAs. Surgical outcomes and radiological and endocrinological characteristics were compared.

Results: Strong female predominance was observed in the SCA group (p<0.001). Cavernous sinus invasion was identified in 22 (40%) SCA patients and 72 (17.6%) HNA patients (p<0.001). There were no differences in ACTH or cortisol levels between the two groups. The incidence of preoperative hypopituitarism and postoperative hormonal outcome did not differ between two groups. Total resection was achieved in 35 patients (63.7%) with SCA and 332 patients (80.8%) with HNA (p=0.007). When tumors were completely removed, recurrence rates were not statistically different between two groups (p=0.60). When complete resection was not achieved, tumors regrew from these remnants in seven patients (35.0%) with SCA and 12 patients (15.2%) with HNA (p=0.05).

Conclusion: Total surgical resection for SCA is often challenging as these tumors frequently invade a cavernous sinus. Early remnant tumor intervention is justified, because untreated residual pituitary tumors regrow when patients were followed up for a long time. Prophylactic radiotherapy is not warranted for completely resected SCAs as tumor recurrence is uncommon.

키워드

Adrenocorticotropic hormone; Corticotrophs; Pituitary neoplasms

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