Clinical Course and Unique Features of Silent Corticotroph Adenomas

Objective: Silent corticotroph adenomas (SCAs) behave more aggressively than other non-functioning adenomas (NFAs). This study aims to expand the body of knowledge of the behavior of SCAs.

Methods: Retrospective analysis of 196 non-corticotroph NFAs and 20 SCAs from 2012-2017 was completed. Demographics, clinical presentation, imaging, and biochemical data were gathered. The primary endpoint was to identify features of SCAs versus other NFAs that suggest aggressive disease, including pre-surgical comorbidities, postoperative complications, extent of tumor, and recurrence. Golden-angle radial sparse parallel (GRASP) magnetic resonance images were obtained from a subset of SCAs and NFAs. Permeability data were obtained to compare signal-to-time curve variation between the 2 groups.

Results: With multivariate regression analysis, SCAs showed higher rates of hemorrhage on preoperative imaging than NFAs (P = 0.017). SCAs presented more frequently with headache (P = 0.012), vision changes (P = 0.041), and fatigue (P = 0.028). SCAs exhibited greater extent of tumor burden with increased occurrence of stalk deviation (P = 0.008), suprasellar invasion (P = 0.021), optic chiasm compression (P = 0.022), and cavernous sinus invasion (P = 0.015). On GRASP imaging, SCAs had significantly lower permeability of contrast than NFAs (P = 0.001). Thirty percent of SCAs were noted to recur with a 14% recurrence rate in other NFAs, though this difference was not of statistical significance (P = 0.220).

Conclusions: SCAs exhibit features of more aggressive disease. Interestingly, a significant increase in recurrence was not seen despite these features. The results of this study support the growing body of evidence that SCAs behave more aggressively than other NFPAs and was able to provide some insight into factors that may contribute to recurrence.