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Sahakian N, Goetz L, Appay R, Graillon T, Raingeard I, Piazzola C, Regis J, Castinetti F, Brue T, Dufour H, Cuny T. Outcome of non-functioning ACTH pituitary tumors: silent does not mean indolent. Pituitary 2024:10.1007/s11102-024-01428-6. [PMID: 38995473 DOI: 10.1007/s11102-024-01428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Silent corticotroph tumors (siACTH) represent a rare entity of pituitary tumors (PT), usually more aggressive than other PT. Few predictor factors of recurrence in the post-operative period have been proposed until now. This study aimed (1) to evaluate the clinical outcome of siACTH after surgery according to a five-tiered clinicopathological classification (2) to compare siACTH characteristics to ACTH-secreting macroadenomas (macroCD), and silent gonadotropinomas (siLH/FSH). PATIENTS AND METHODS Between 2008 and 2022, 29 siACTH out of 865 PT cases operated in one tertiary center were included. Clinical, paraclinical, histological, and surgical data were collected and compared to 25 macroCD and 143 siLH/FSH cases, respectively. The tumor grading was established according to both invasion (no = 1; yes = 2) and proliferation (no = a; yes = b). Progression-free survival was estimated using Kaplan-Meier method and log-rank test. RESULTS We identified 15 (51.7%) grade 1a, 11 (37.9%) grade 2a and 3 (10.3%) grade 2b siACTH with a trend for a 7-fold-time higher risk of progression/recurrence in grade 2b as compared to 1a (p = 0.06). The repartition of tumor grades was similar between the three subgroups, however a 5.7-fold-higher risk of progression was observed in grade 1a siACTH than in grade 1a siLH/FSH (p = 0.02). Compared to siLH/FSH, higher ACTH levels may help to preoperatively identify siACTH. CONCLUSION The five-tiered clinicopathological classification contribute to predict the risk of recurrence of operated siACTH tumors. Noteworthy, non-invasive and non-proliferative siACTH exhibit a less favorable outcomes than their siLH/FSH counterparts, which should prompt for a personalized follow up.
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Affiliation(s)
- Nicolas Sahakian
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception University Hospital, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Lise Goetz
- Department of Endocrinology, University Hospital of Montpellier, Montpellier, France
| | - Romain Appay
- Department of Pathological Anatomy and Neuropathology, Timone Hospital, APHM, Marseille, France
| | - Thomas Graillon
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, Timone Hospital, Department of Neurosurgery, CRMR HYPO, Marseille, France
| | - Isabelle Raingeard
- Department of Endocrinology, University Hospital of Montpellier, Montpellier, France
| | - Cécilia Piazzola
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception University Hospital, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Jean Regis
- Department of Functional and Stereotactic Neurosurgery, CHU Timone, Aix Marseille University, INS-UMR1106, Marseille, 13385, France
| | - Frédéric Castinetti
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception University Hospital, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Thierry Brue
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception University Hospital, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Henry Dufour
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, Timone Hospital, Department of Neurosurgery, CRMR HYPO, Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception University Hospital, Department of Endocrinology, CRMR HYPO, Marseille, France.
- Aix Marseille Univ, Hôpital de la Conception, Clinical Investigation Centre 1409, Inserm, Marseille, France.
- Service d'Endocrinologie, Hôpital de la Conception, APHM, 147 Boulevard Baille, Marseille, 13005, France.
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Vuong HG, Dunn IF. The clinicopathological features and prognosis of silent corticotroph tumors: an updated systematic review and meta-analysis. Endocrine 2023; 82:527-535. [PMID: 37462809 DOI: 10.1007/s12020-023-03449-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/06/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Data on silent corticotroph tumor (SCT) are still heterogeneous and controversial. In this study, we aimed to compare the demographic, clinicopathological manifestations, postoperative complications, and patient outcomes of SCTs with other non-functioning pituitary neuroendocrine tumor (NFT) and functioning corticotroph tumor (FCT) or so-called Cushing disease adenoma. METHODS We searched PubMed and Web of Science for data of interest. Odds ratio (OR), mean difference (MD), hazard ratio (HR), and their 95% confidence intervals (CI) were pooled using the random-effect model. RESULTS Twenty-nine studies with 985 SCTs were included in meta-analyses. In comparison to other NFTs, SCTs were more commonly associated with female gender, younger age, cavernous sinus invasion, apoplexy, and radiotherapy administration. Postoperatively, SCT patients were more likely to experience hypocortisolism, new-onset visual disturbances, and a higher risk for tumor progression than other NFTs. We did not find any significant differences between SCT type I and type II. Compared to FCTs, SCTs were more likely male, older age, and had larger tumor sizes. The prevalence of a USP8 mutation was significantly higher in FCT than in SCT. CONCLUSION SCT was demographically, clinicopathologically, and prognostically distinct from other NFTs and FCTs. These tumors should be considered high-risk; appropriate treatment decisions and more stringent follow-up should be tailored to improve patient outcomes.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, US
| | - Ian F Dunn
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, US.
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Editorial Comment: Radiomics analysis allows for precise prediction of silent corticotroph adenoma among non-functioning pituitary adenomas. Eur Radiol 2022; 32:1475-1476. [DOI: 10.1007/s00330-021-08509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022]
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Jiang S, Chen X, Wu Y, Wang R, Bao X. An Update on Silent Corticotroph Adenomas: Diagnosis, Mechanisms, Clinical Features, and Management. Cancers (Basel) 2021; 13:cancers13236134. [PMID: 34885244 PMCID: PMC8656508 DOI: 10.3390/cancers13236134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The 2017 World Health Organization classification of endocrine tumors defines pituitary adenomas based on their cell lineages. T-PIT can serve as a complimentary tool for further identification of silent corticotroph adenomas (SCAs). Unlike functioning corticotroph adenomas in patients with Cushing’s disease, SCAs present no clinical and biochemical features of Cushing’s syndrome. SCAs have been shown to exhibit a more aggressive course characterized by a higher probability of recurrence and resistance to conventional treatment due to their intrinsic histological features. The aim of our review is to offer an update on the diagnosis, mechanisms, clinical features and management of SCAs. Studies of the molecular mechanisms of SCA pathogenesis will provide new directions for the diagnosis and management of SCAs. Abstract With the introduction of 2017 World Health Organization (WHO) classification of endocrine tumors, T-PIT can serve as a complementary tool for identification of silent corticotroph adenomas (SCAs) in some cases if the tumor is not classifiable by pituitary hormone expression in pathological tissue samples. An increase of the proportion of SCAs among the non-functioning pituitary adenomas (NFPAs) has been witnessed under the new rule with the detection of T-PIT-positive ACTH-negative SCAs. Studies of molecular mechanisms related to SCA pathogenesis will provide new directions for the diagnosis and management of SCAs. A precise pathological diagnosis can help clinicians better identify SCAs. Understanding clinical features in the context of the pathophysiology of SCAs is critical for optimal management. It could provide information on appropriate follow-up time and aid in early recognition and treatment of potentially aggressive forms. Management approaches include surgical, radiation, and/or medical therapies.
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Rui W, Qiao N, Wu Y, Zhang Y, Aili A, Zhang Z, Ye H, Wang Y, Zhao Y, Yao Z. Radiomics analysis allows for precise prediction of silent corticotroph adenoma among non-functioning pituitary adenomas. Eur Radiol 2021; 32:1570-1578. [PMID: 34837512 DOI: 10.1007/s00330-021-08361-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 09/01/2021] [Accepted: 09/25/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To predict silent corticotroph adenomas (SCAs) among non-functioning pituitary adenomas preoperatively using noninvasive radiomics. METHODS A total of 302 patients including 146 patients diagnosed with SCAs and 156 patients with non-SCAs were enrolled (training set: n = 242; test set: n = 60). Tumor segmentation was manually generated using ITK-SNAP. From T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and contrast-enhanced T1WI, 2550 radiomics features were extracted using Pyradiomics. Pearson's correlation coefficient values were calculated to exclude redundant features. Several machine learning algorithms were developed to predict SCAs incorporating the radiomics and semantic features including clinical, laboratory, and radiology-associated features. The performance of models was evaluated by AUC. RESULTS Patients in the SCA group were younger (49.5 vs 55.2 years old) and more female (85.6% vs 37.2%) than those in the non-SCA group (p < 0.001). More invasiveness (p = 0.011) and cystic and microcystic change (p < 0.001) were observed in patients with SCAs. The ensemble algorithm presented the largest AUC of 0.927 among all the algorithms trained in the test set, and the accuracy, specificity, and sensitivity of predicting SCAs were all 0.867 (at cut-off 0.5). The overall model performed better than that only using semantic features available in the clinic. Radiomics prediction was the most important feature, with gender ranking second and age ranking third. Radiomics features on T2WI were superior to those on other MR modalities in SCA prediction. CONCLUSION Our ensemble learning model outperformed current clinical practice in differentiating patients with SCAs and non-SCAs using radiomics, which might help make appropriate treatment strategies. KEY POINTS • Radiomics might improve the preoperative diagnosis of SCAs by MR images. • T2WI was superior to T1WI and CE-T1WI in the preoperative diagnosis of SCAs. • The ensemble machine learning model outperformed current clinical practice in SCAs diagnosis and treatment decision-making could be more individualised using the nomogram.
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Affiliation(s)
- Wenting Rui
- Department of Radiology, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, People's Republic of China
| | - Nidan Qiao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, People's Republic of China.,Neurosurgical Institute of Fudan University, Shanghai, People's Republic of China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, People's Republic of China.,National Center for Neurological Disorders, Shanghai, People's Republic of China
| | - Yue Wu
- Department of Radiology, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, People's Republic of China
| | - Yong Zhang
- GE Healthcare, MR Research, Huatuo Road, Shanghai, 201203, People's Republic of China
| | - Ababikere Aili
- Department of Radiology, Kuqa County People's Hospital, Aksu, 842000, Xinjiang, People's Republic of China
| | - Zhaoyun Zhang
- Department of Endocrinology, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, People's Republic of China
| | - Hongying Ye
- Department of Endocrinology, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, People's Republic of China
| | - Yongfei Wang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, People's Republic of China.,Neurosurgical Institute of Fudan University, Shanghai, People's Republic of China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, People's Republic of China.,National Center for Neurological Disorders, Shanghai, People's Republic of China
| | - Yao Zhao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, People's Republic of China. .,Neurosurgical Institute of Fudan University, Shanghai, People's Republic of China. .,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People's Republic of China. .,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, People's Republic of China. .,National Center for Neurological Disorders, Shanghai, People's Republic of China.
| | - Zhenwei Yao
- Department of Radiology, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, People's Republic of China.
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Goyal-Honavar A, Sarkar S, Asha HS, Kapoor N, Balakrishnan R, Vanjare H, Chacko G, Chacko AG. A clinicoradiological analysis of silent corticotroph adenomas after the introduction of pituitary-specific transcription factors. Acta Neurochir (Wien) 2021; 163:3143-3154. [PMID: 34181087 DOI: 10.1007/s00701-021-04911-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Silent corticotroph adenomas (SCAs) are a rare subtype of non-functional pituitary adenoma. While it has been suggested that they are more aggressive and recur more frequently following excision, there is limited literature on the optimum treatment strategy for these tumors, especially regarding the role of radiation therapy in incompletely resected tumors. METHOD We assimilated data from 62 SCAs and 238 other non-functional adenomas (ONAs), defined according to the WHO 2017 criteria that incorporates transcription factor analysis. We compared their clinicoradiological characteristics, such as hormonal levels, tumor configuration, size, and invasiveness. For 52 SCAs and 205 ONAs with serial follow-up imaging, we studied outcomes for progression after subtotal resection with or without radiation therapy or recurrence after gross total resection. Kaplan Meier analysis for recurrence or progression was used to determine the need for a differential treatment strategy for SCAs compared with other non-functional adenomas specifically concerning the role of radiotherapy. RESULTS Patients with SCAs present at a younger age than ONAs (43.9 years vs. 48.2 years, p = 0.014), with larger (14.9 cc vs. 9.7 cc, p = 0.006) and more invasive adenomas (61.2% vs. 45.8%, p = 0.021). Overall, SCAs are more likely to recur or progress (48.7 vs. 15.7%, p < 0.001) following excision than ONAs, with significantly poorer event-free survival (Log rank test p < 0.001). Early adjuvant radiotherapy provides favorable outcomes among SCAs with postoperative residual tumor, on par with ONAs. Multivariate analysis identified male gender (HR: 2.217; p = 0.017), MIB index ≥ 3% (HR: 2.116; p = 0.012), and SCA tumor pathology (HR: 3.787; p < 0.001) as factors predicting recurrence. CONCLUSIONS Based on the results of this retrospective, single-center review of 300 non-functional adenomas, we conclude that silent corticotroph adenomas are an aggressive subtype of non-functional pituitary adenomas that are larger, more likely to be invasive, and tend to recur more frequently after a subtotal excision compared with other non-functional adenomas. A gross total resection must be attempted whenever possible and earlier adjuvant radiation is recommended when re-surgery for residual tumor is difficult.
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Zhang K, Shou X, Chen H, Qiao N, He W, Chen Z, Shen M, Li S, Zhao Y, Zhang Z, Li Y, Ye H, Wang Y. Clinical Parameters of Silent Corticotroph Adenomas With Positive and Negative Adrenocorticotropic Hormone Immunostaining: A Large Retrospective Single-Center Study of 105 Cases. Front Endocrinol (Lausanne) 2021; 11:608691. [PMID: 33584540 PMCID: PMC7873875 DOI: 10.3389/fendo.2020.608691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022] Open
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. 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. 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). 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).
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Affiliation(s)
- Keyi Zhang
- Department of Neurosurgery, Shanghai Huashan Institute of Neurological Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Xuefei Shou
- Department of Neurosurgery, Shanghai Huashan Institute of Neurological Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Hong Chen
- Department of Pathology, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Nidan Qiao
- Department of Neurosurgery, Shanghai Huashan Institute of Neurological Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Wenqiang He
- Department of Neurosurgery, Shanghai Huashan Institute of Neurological Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Zhengyuan Chen
- Department of Neurosurgery, Shanghai Huashan Institute of Neurological Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Ming Shen
- Department of Neurosurgery, Shanghai Huashan Institute of Neurological Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Shiqi Li
- Department of Neurosurgery, Shanghai Huashan Institute of Neurological Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yao Zhao
- Department of Neurosurgery, Shanghai Huashan Institute of Neurological Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Zhaoyun Zhang
- Department of Endocrinology, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yiming Li
- Department of Endocrinology, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Hongying Ye
- Department of Endocrinology, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yongfei Wang
- Department of Neurosurgery, Shanghai Huashan Institute of Neurological Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
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Hinojosa-Amaya JM, Lam-Chung CE, Cuevas-Ramos D. Recent Understanding and Future Directions of Recurrent Corticotroph Tumors. Front Endocrinol (Lausanne) 2021; 12:657382. [PMID: 33986726 PMCID: PMC8111286 DOI: 10.3389/fendo.2021.657382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Corticotroph tumors (CTs) are pituitary neoplasms arising from the Tpit lineage, which may or not express adrenocorticotrophic hormone (ACTH). Functioning CTs cause Cushing's disease (CD), which has high morbidity and mortality due to hypercortisolemia. "Non-functioning" or silent CTs (SCT) and the Crooke's cell subtypes do not cause CD and may be asymptomatic until manifested by compressive symptoms and are more frequently found as macroadenoma. Both tend toward more aggressive behavior, recurrence, and a higher rate of malignant transformation to pituitary carcinoma. Tumorigenesis involves genetic, epigenetic, and post-transcriptional disruption of cell-cycle regulators, which increase cell proliferation, POMC overexpression, ACTH transcription, and/or hypersecretion. Furthermore, functioning CTs develop resistance to glucocorticoid-mediated negative feedback on ACTH secretion, through increased expression of testicular orphan nuclear receptor 4 (TR4), heat-shock protein 90 (HSP90), and loss-of-function mutation of CDK5 and ABL enzyme substrate 1 (CABLES1) gene. Overt autonomous hypercortisolemia is difficult to control, and multiple diagnostic studies and therapeutic modalities are commonly required. Cell-cycle regulation depends mainly on p27, cyclin E, cyclin-dependent kinases (CDKs), and the retinoblastoma protein (Rb)/E2F1 transcription factor complex. Gain-of-function mutations of ubiquitin-specific protease (USP) 8, USP48, and BRAF genes may subsequently cause overexpression of epithelial growth factor receptor (EGFR), and enhance POMC transcription, cell proliferation, and tumor growth. Epigenetic changes through micro RNAs and decreased DNA deacetylation by histone deacetylase type 2 (HDAC2), may also affect tumor growth. All the former mechanisms may become interesting therapeutic targets for CTs, aside from temozolomide, currently used for aggressive tumors. Potential therapeutic agents are EGFR inhibitors such as gefitinib and lapatinib, the purine analog R-roscovitine by dissociation of CDK2/Cyclin E complex, the HSP90 inhibitor silibinin (novobiocin), to reduce resistance to glucocorticoid-mediated negative feedback, and BRAF inhibitors vemurafenib and dabrafenib in BRAF V600E positive tumors. This review summarizes the molecular mechanisms related to CTs tumorigenesis, their diagnostic approach, and provides an update of the potential novel therapies, from the lab bench to the clinical translation.
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Affiliation(s)
- José Miguel Hinojosa-Amaya
- Pituitary Clinic, Endocrinology Division, Department of Medicine, Hospital Universitario “Dr. José E. González” UANL, Monterrey, Mexico
| | - César Ernesto Lam-Chung
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Daniel Cuevas-Ramos
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- *Correspondence: Daniel Cuevas-Ramos,
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AKKUŞ G, KARAGÜN B, ÇETİNALP NE, AÇIKALIN A, ODABAŞ F, EVRAN OLGUN M, SERT M, ZORLUDEMİR S, TETİKER BT. Klinik olarak belirgin Cushing hastalığı olan hastalar ile sessiz kortikotrof hücreli adenomu olan hastaların klinik, hormonal, radyolojik ve morfolojik olarak karşılaştırılması. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.783225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Jahan S, Hasanat MA, Mahmood T, Morshed S, Haq R, Fariduddin M. Postoperative expression of Cushing disease in a young male: metamorphosis of silent corticotroph adenoma? Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190046. [PMID: 31671410 PMCID: PMC6790907 DOI: 10.1530/edm-19-0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022] Open
Abstract
SUMMARY Silent corticotroph adenoma (SCA) is an unusual type of nonfunctioning pituitary adenoma (NFA) that is silent both clinically and biochemically and can only be recognized by positive immunostaining for ACTH. Under rare circumstances, it can transform into hormonally active disease presenting with severe Cushing syndrome. It might often produce diagnostic dilemma with difficult management issue if not thoroughly investigated and subtyped accordingly following surgery. Here, we present a 21-year-old male who initially underwent pituitary adenomectomy for presumed NFA with compressive symptoms. However, he developed recurrent and invasive macroadenoma with severe clinical as well as biochemical hypercortisolism during post-surgical follow-up. Repeat pituitary surgery was carried out urgently as there was significant optic chiasmal compression. Immunohistochemical analysis of the tumor tissue obtained on repeat surgery proved it to be an aggressive corticotroph adenoma. Though not cured, he showed marked clinical and biochemical improvement in the immediate postoperative period. Anticipating recurrence from the residual tumor, we referred him for cyber knife radio surgery. LEARNING POINTS Pituitary NFA commonly present with compressive symptoms such as headache and blurred vision. Post-surgical development of Cushing syndrome in such a case could be either drug induced or endogenous. In the presence of recurrent pituitary tumor, ACTH-dependent Cushing syndrome indicates CD. Rarely a SCA presenting initially as NFA can transform into an active corticotroph adenoma. Immunohistochemical marker for ACTH in the resected tumor confirms the diagnosis.
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Affiliation(s)
- Sharmin Jahan
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - M A Hasanat
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Tahseen Mahmood
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Shahed Morshed
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Raziul Haq
- Department of Neurosurgery, Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh
| | - Md Fariduddin
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Prevalence of Thyroid Disease in Patients Surgically Treated for Pituitary Disease. J Clin Med 2019; 8:jcm8081142. [PMID: 31370339 PMCID: PMC6722506 DOI: 10.3390/jcm8081142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022] Open
Abstract
Thyroid disease mainly has a thyroid origin but can occasionally have a pituitary origin. Clinicians face several challenges when these conditions occur together. We aimed to determine the prevalence of thyroid disorders in patients undergoing trans-sphenoidal adenomectomy (TSA) for pituitary disease. We reviewed the medical records of patients undergoing TSA for pituitary disease between 2008 and 2017 at Severance Hospital. Thyroid disorders were categorized using blood test results and medical histories at the time of preoperative evaluation. Among 2202 patients, 44 (2%), 218 (9.9%), and 74 (3.4%) had hyperthyroidism, hypothyroidism, and post-thyroidectomy status before TSA, respectively. Among the 44 patients with hyperthyroidism, 30 (68.2%) had central hyperthyroidism. Among the 218 patients with hypothyroidism, 165 (75.7%) had central hypothyroidism. Central hypothyroidism was more common in patients with adrenocorticotropic hormone-secreting pituitary adenomas (aOR (adjusted odds ratio) 1.85), Rathke’s cleft cysts (aOR 2.34), and craniopharyngiomas (aOR 2.58) (all p < 0.05) than in those with nonfunctioning pituitary adenomas. Contrastingly, thyroid cancer had an increased prevalence in patients with growth hormone- (aOR 3.17), prolactin- (aOR 3.66), and thyroid-stimulating hormone-secreting (aOR 6.28) pituitary adenomas (all p < 0.05). Pituitary disease sometimes accompanies thyroid disorders; their characteristics vary according to the type of pituitary disease.
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Batista RL, Trarbach EB, Marques MD, Cescato VA, da Silva GO, Herkenhoff CGB, Cunha-Neto MB, Musolino NR. Nonfunctioning Pituitary Adenoma Recurrence and Its Relationship with Sex, Size, and Hormonal Immunohistochemical Profile. World Neurosurg 2018; 120:e241-e246. [PMID: 30138730 DOI: 10.1016/j.wneu.2018.08.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Tumor recurrence or incomplete resection in nonfunctioning pituitary adenomas (NFPAs) is relatively common. However, predictive factors of tumor recurrence in NFPAs are not well established. We evaluated possible factors related to tumor recurrence in a large cohort of NFPAs at a single pituitary neurosurgery center. METHODS A retrospective analysis was conducted of 410 medical records of patients with NFPAs treated by transsphenoidal surgery between 2000 and 2014. RESULTS Among the participants, 210 were female (51.0%). A total of 14.1% had giant adenomas. Null-cell pituitary adenomas (n = 239; 58.9%) were the most frequent, followed by silent gonadotroph adenomas (n = 112; 27.3%). Null-cell adenomas were more frequent in women (P = 0.008) and silent gonadotroph adenomas were more frequent in men (P = 0.004). Recurrence was not related to sex or age. Tumor recurrence occurred more often among silent corticotropic adenomas and giant adenomas (hazard ratio 2.45; P < 0.0001 and hazard ratio 2.35; P = 0.001, respectively). Silent thyrotrophic adenoma presented a comparable frequency of recurrence of silent corticotropic adenomas, despite having borderline significance (P = 0.07). CONCLUSIONS NFPA tumors have a high heterogeneous hormonal profile and may have prognostic importance. Silent corticotropic adenomas and giant adenomas present a high rate of recurrence.
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Affiliation(s)
| | - Ericka Barbosa Trarbach
- Molecular and Cellular Laboratory - LIM/25, Endocrinology Discipline, Hospital das Clínicas da Universidade de São Paulo - HCFMUSP, São Paulo, Brazil
| | - Mateus Diniz Marques
- Clinical Medicine Departament, Health Sciences Centre, Universidade Federal de Santa Maria, Santa Maria/RS, Brazil
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