Download PDF
CC BY-NC-ND 4.0 · J Neurol Surg Rep 2022; 83(02): e33-e38
DOI: 10.1055/s-0042-1749389
Case Report

Silent Corticotroph and Somatotroph Double Pituitary Adenoma: A Case Report and Review of Literature

Isabella L. Pecorari 
1   Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
2   Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Lakshmi Priyanka Mahali
3   Department of Endocrinology, Albert Einstein College of Medicine, Bronx, New York, United States
4   Department of Endocrinology, Montefiore Medical Center, Bronx, New York, United States
,
Abigail Funari
1   Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
2   Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Roger Fecher
5   Department of Anatomic and Clinical Pathology, Albert Einstein College of Medicine, Bronx, New York, United States
6   Department of Anatomic and Clinical Pathology, Montefiore Medical Center, Bronx, New York, United States
,
Nisha Suda
3   Department of Endocrinology, Albert Einstein College of Medicine, Bronx, New York, United States
4   Department of Endocrinology, Montefiore Medical Center, Bronx, New York, United States
,
Vijay Agarwal
1   Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
2   Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Clinically silent double pituitary adenomas consisting of corticotroph and somatotroph cells are an exceedingly rare clinical finding. In this report, we present the case of a 28-year-old man with a 1-year history of recurrent headaches. Imaging revealed a 2.1 (anterior-posterior) × 2.2 (transverse) × 1.3 (craniocaudal) cm pituitary adenoma invading into the left cavernous sinus and encasing the left internal carotid artery. Endoscopic transnasal resection was performed without complications. Immunohistochemical staining revealed a double adenoma consisting of distinct sparsely granulated somatotroph and densely granulated corticotroph cells that were positive for growth hormone and adrenocorticotropic hormone, respectively. Ki-67 index labeling revealed a level of 6% within the corticotroph adenoma. No increase in serum growth hormone or adrenocorticotropic hormone was found, indicating a clinically silent double adenoma. While transsphenoidal surgery remains a first-line approach for silent adenomas presenting with mass effects, increased rates of proliferative markers, such as the Ki-67 index, provide useful insight into the clinical course of such tumors. Determining the Ki-67 index of silent pituitary adenomas could be valuable in predicting recurrence after initial surgical resection and identifying tumors that are at an increased risk of needing additional therapeutic interventions or more frequent surveillance imaging.

Keywords

double pituitary adenoma - somatotroph - corticotroph - Ki-67


Publication History

Received: 17 November 2021

Accepted: 29 March 2022

Article published online:
27 May 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Drummond J, Roncaroli F, Grossman AB, Korbonits M. Clinical and pathological aspects of silent pituitary adenomas. J Clin Endocrinol Metab 2019; 104 (07) 2473-2489
    CrossrefPubMedGoogle Scholar
  • 2 Mayson SE, Snyder PJ. Silent (clinically nonfunctioning) pituitary adenomas. J Neurooncol 2014; 117 (03) 429-436
    CrossrefPubMedGoogle Scholar
  • 3 Larkin S, Ansorge O. Pathology and Pathogenesis of Pituitary Adenomas and Other Sellar Lesions. PubMed; 2000. Accessed November 11, 2021 at: https://www.ncbi.nlm.nih.gov/books/NBK425704/
    PubMedGoogle Scholar
  • 4 Cooper O, Melmed S. Subclinical hyperfunctioning pituitary adenomas: the silent tumors. Best Pract Res Clin Endocrinol Metab 2012; 26 (04) 447-460
    CrossrefPubMedGoogle Scholar
  • 5 Ben-Jonathan N, Hnasko R. Dopamine as a prolactin (PRL) inhibitor. Endocr Rev 2001; 22 (06) 724-763
    CrossrefPubMedGoogle Scholar
  • 6 Wade AN, Baccon J, Grady MS, Judy KD, O'Rourke DM, Snyder PJ. Clinically silent somatotroph adenomas are common. Eur J Endocrinol 2011; 165 (01) 39-44
    CrossrefPubMedGoogle Scholar
  • 7 Lopes MBS. The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. Acta Neuropathol 2017; 134 (04) 521-535
    CrossrefPubMedGoogle Scholar
  • 8 Chinezu L, Vasiljevic A, Trouillas J, Lapoirie M, Jouanneau E, Raverot G. Silent somatotroph tumour revisited from a study of 80 patients with and without acromegaly and a review of the literature. Eur J Endocrinol 2017; 176 (02) 195-201
    CrossrefPubMedGoogle Scholar
  • 9 Langlois F, Lim DST, Varlamov E. et al. Clinical profile of silent growth hormone pituitary adenomas; higher recurrence rate compared to silent gonadotroph pituitary tumors, a large single center experience. Endocrine 2017; 58 (03) 528-534
    CrossrefPubMedGoogle Scholar
  • 10 Langlois F, Woltjer R, Cetas JS, Fleseriu M. Silent somatotroph pituitary adenomas: an update. Pituitary 2018; 21 (02) 194-202
    CrossrefPubMedGoogle Scholar
  • 11 Nishioka H, Inoshita N, Mete O. et al. The complementary role of transcription factors in the accurate diagnosis of clinically nonfunctioning pituitary adenomas. Endocr Pathol 2015; 26 (04) 349-355
    CrossrefPubMedGoogle Scholar
  • 12 Cooper O. Silent corticotroph adenomas. Pituitary 2015; 18 (02) 225-231
    CrossrefPubMedGoogle Scholar
  • 13 Mete O, Lopes MB. Overview of the 2017 WHO Classification of Pituitary Tumors. Endocr Pathol 2017; 28 (03) 228-243
    CrossrefPubMedGoogle Scholar
  • 14 Saeger W, Lüdecke DK, Buchfelder M, Fahlbusch R, Quabbe H-J, Petersenn S. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol 2007; 156 (02) 203-216
    CrossrefPubMedGoogle Scholar
  • 15 Mete O, Hayhurst C, Alahmadi H. et al. The role of mediators of cell invasiveness, motility, and migration in the pathogenesis of silent corticotroph adenomas. Endocr Pathol 2013; 24 (04) 191-198
    CrossrefPubMedGoogle Scholar
  • 16 Pappy II AL, Savinkina A, Bicknese C, Neill S, Oyesiku NM, Ioachimescu AG. Predictive modeling for pituitary adenomas: single center experience in 501 consecutive patients. Pituitary 2019; 22 (05) 520-531
    CrossrefPubMedGoogle Scholar
  • 17 Kontogeorgos G, Scheithauer BW, Horvath E. et al. Double adenomas of the pituitary: a clinicopathological study of 11 tumors. Neurosurgery 1992; 31 (05) 840-849 , discussion 849
    CrossrefPubMedGoogle Scholar
  • 18 Ogando-Rivas E, Alalade AF, Boatey J, Schwartz TH. Double pituitary adenomas are most commonly associated with GH- and ACTH-secreting tumors: systematic review of the literature. Pituitary 2017; 20 (06) 702-708
    CrossrefPubMedGoogle Scholar
  • 19 Shimizu C, Koike T, Sawamura Y. Double pituitary adenomas with distinct histological features and immunophenotypes. J Neurol Neurosurg Psychiatry 2004; 75 (01) 140-140
    PubMedGoogle Scholar
  • 20 Budan RM, Georgescu CE. Multiple pituitary adenomas: a systematic review. Front Endocrinol (Lausanne) 2016; 7: 1
    CrossrefPubMedGoogle Scholar
  • 21 Rasul FT, Jaunmuktane Z, Khan AA, Phadke R, Powell M. Plurihormonal pituitary adenoma with concomitant adrenocorticotropic hormone (ACTH) and growth hormone (GH) secretion: a report of two cases and review of the literature. Acta Neurochir (Wien) 2014; 156 (01) 141-146
    CrossrefPubMedGoogle Scholar
  • 22 Iacovazzo D, Bianchi A, Lugli F. et al. Double pituitary adenomas. Endocrine 2013; 43 (02) 452-457
    CrossrefPubMedGoogle Scholar
  • 23 Abe T, Taniyama M, Xu B. et al. Silent mixed corticotroph and somatotroph macroadenomas presenting with pituitary apoplexy. Acta Neuropathol 2001; 102 (05) 435-440
    CrossrefPubMedGoogle Scholar
  • 24 Gerdes J, Lemke H, Baisch H, Wacker HH, Schwab U, Stein H. Cell cycle analysis of a cell proliferation-associated human nuclear antigen defined by the monoclonal antibody Ki-67. J Immunol 1984; 133 (04) 1710-1715
    CrossrefPubMedGoogle Scholar
  • 25 Hasanov R, Aydoğan Bİ, Kiremitçi S, Erden E, Güllü S. The prognostic roles of the Ki-67 proliferation index, P53 expression, mitotic index, and radiological tumor invasion in pituitary adenomas. Endocr Pathol 2019; 30 (01) 49-55
    CrossrefPubMedGoogle Scholar
  • 26 Liu C, Li Z, Wu D, Li C, Zhang Y. Smad3 and phospho-Smad3 are potential markers of invasive nonfunctioning pituitary adenomas. Onco Targets Therap 2016; 9: 2265-2271
    CrossrefPubMedGoogle Scholar
  • 27 Šteňo A, Bocko J, Rychlý B. et al. Nonfunctioning pituitary adenomas: association of Ki-67 and HMGA-1 labeling indices with residual tumor growth. Acta Neurochir (Wien) 2014; 156 (03) 451-461 , discussion 461
    CrossrefPubMedGoogle Scholar
  • 28 Penn DL, Burke WT, Laws ER. Management of non-functioning pituitary adenomas: surgery. Pituitary 2018; 21 (02) 145-153
    CrossrefPubMedGoogle Scholar
  • 29 Jahangiri A, Wagner JR, Pekmezci M. et al. A comprehensive long-term retrospective analysis of silent corticotrophic adenomas vs hormone-negative adenomas. Neurosurgery 2013; 73 (01) 8-17 , discussion 17–18
    CrossrefPubMedGoogle Scholar
  • 30 Yamada S, Ohyama K, Taguchi M. et al. A study of the correlation between morphological findings and biological activities in clinically nonfunctioning pituitary adenomas. Neurosurgery 2007; 61 (03) 580-584 , discussion 584–585
    CrossrefPubMedGoogle Scholar
  • 31 Pawlikowski M, Kunert-Radek J, Radek M. “Silent” corticotropinoma. Neuroendocrinol Lett 2008; 29 (03) 347-350
    PubMedGoogle Scholar
  • 32 Langlois F, Lim DST, Yedinak CG. et al. Predictors of silent corticotroph adenoma recurrence; a large retrospective single center study and systematic literature review. Pituitary 2018; 21 (01) 32-40
    CrossrefPubMedGoogle Scholar
  • 33 Cooper O, Ben-Shlomo A, Bonert V, Bannykh S, Mirocha J, Melmed S. Silent corticogonadotroph adenomas: clinical and cellular characteristics and long-term outcomes. Horm Cancer 2010; 1 (02) 80-92
    CrossrefPubMedGoogle Scholar
  • 34 Cho HY, Cho SW, Kim SW, Shin CS, Park KS, Kim SY. Silent corticotroph adenomas have unique recurrence characteristics compared with other nonfunctioning pituitary adenomas. Clin Endocrinol (Oxf) 2010; 72 (05) 648-653
    CrossrefPubMedGoogle Scholar
  • 35 Naritaka H, Kameya T, Sato Y, Furuhata S, Otani M, Kawase T. Morphological characterization and subtyping of silent somatotroph adenomas. Pituitary 1999; 1 (3-4): 233-241
    CrossrefPubMedGoogle Scholar
  • 36 Kawaguchi T, Ogawa Y, Tominaga T. Early surgical intervention for patients with possible clinically silent somatotroph adenoma: a case series. J Med Case Reports 2019; 13 (01) 85
    CrossrefPubMedGoogle Scholar
  • 37 Zheng G, Lu L, Zhu H. et al. Clinical, laboratory, and treatment profiles of silent corticotroph adenomas that have transformed to the functional type: a case series with a literature review. Front Endocrinol (Lausanne) 2020; 11: 558593
    CrossrefPubMedGoogle Scholar
  • 38 Thapar K, Kovacs K, Scheithauer BW. et al. Proliferative activity and invasiveness among pituitary adenomas and carcinomas: an analysis using the MIB-1 antibody. Neurosurgery 1996; 38 (01) 99-106 , discussion 106–107
    CrossrefPubMedGoogle Scholar
  • 39 Hallén T, Olsson DS, Hammarstrand C. et al. MCM7 as a marker of postsurgical progression in non-functioning pituitary adenomas. Eur J Endocrinol 2021; 184 (04) 521-531
    CrossrefPubMedGoogle Scholar
  • 40 Petry C, Poli JHZ, de Azevedo Dossin I. et al. Evaluation of the potential of the Ki67 index to predict tumor evolution in patients with pituitary adenoma. Int J Clin Exp Pathol 2019; 12 (01) 320-326
    PubMedGoogle Scholar
  • 41 Noh TW, Jeong HJ, Lee MK, Kim TS, Kim SH, Lee EJ. Predicting recurrence of nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 2009; 94 (11) 4406-4413
    CrossrefPubMedGoogle Scholar
  • 42 Liu J, He Y, Zhang X, Yan X, Huang Y. Clinicopathological analysis of 250 cases of pituitary adenoma under the new WHO classification. Oncol Lett 2020; 19 (03) 1890-1898
    PubMedGoogle Scholar
  • 43 Strickland BA, Shahrestani S, Briggs RG. et al. Silent corticotroph pituitary adenomas: clinical characteristics, long-term outcomes, and management of disease recurrence. J Neurosurg 2021; 1: 1-8
    CrossrefPubMedGoogle Scholar
  • 44 Sarkar S, Chacko AG, Chacko G. An analysis of granulation patterns, MIB-1 proliferation indices and p53 expression in 101 patients with acromegaly. Acta Neurochir (Wien) 2014; 156 (12) 2221-2230 , discussion 2230
    CrossrefPubMedGoogle Scholar
  • 45 Jane JA, Catalino MP, Laws ER. Surgical Treatment of Pituitary Adenomas. PubMed; 2000. Accessed November 11, 2021 at: https://www.ncbi.nlm.nih.gov/books/NBK278983/
    PubMedGoogle Scholar
  • 46 O'Sullivan EP, Woods C, Glynn N. et al. The natural history of surgically treated but radiotherapy-naïve nonfunctioning pituitary adenomas. Clin Endocrinol (Oxf) 2009; 71 (05) 709-714
    CrossrefPubMedGoogle Scholar
  • 47 Goyal-Honavar A, Sarkar S, Asha HS. et al. A clinicoradiological analysis of silent corticotroph adenomas after the introduction of pituitary-specific transcription factors. Acta Neurochir (Wien) 2021; 163 (11) 3143-3154
    CrossrefPubMedGoogle Scholar
  • 48 Xu Z, Ellis S, Lee CC. et al. Silent corticotroph adenomas after stereotactic radiosurgery: a case-control study. Int J Radiat Oncol Biol Phys 2014; 90 (04) 903-910
    CrossrefPubMedGoogle Scholar