Clinically silent somatotroph adenomas are common
Open Access
- 1 July 2011
- journal article
- Published by Oxford University Press (OUP) in Acta Endocrinologica
- Vol. 165 (1), 39-44
- https://doi.org/10.1530/eje-11-0216
Abstract
Somatotroph adenomas are typically recognized when they secrete GH excessively and cause acromegaly. Both ‘silent’ somatotroph adenomas (immunohistochemical evidence of GH excess without biochemical or clinical evidence) and ‘clinically silent’ somatotroph adenomas (immunohistochemical and biochemical evidence but no clinical evidence) have occasionally been reported. The relative frequency of each presentation is unknown. The goal of this study was, therefore, to determine the frequency of clinically silent somatotroph adenomas, a group that is potentially recognizable in vivo. We retrospectively identified 100 consecutive patients who had surgically excised and histologically confirmed pituitary adenomas. Each pituitary adenoma was classified immunohistochemically by pituitary cell type. Somatotroph adenomas were further classified as ‘classic’ (obvious clinical features of acromegaly and elevated serum IGF1), ‘subtle’ (subtle clinical features of acromegaly and elevated IGF1), ‘clinically silent’ (no clinical features of acromegaly but elevated IGF1), and ‘silent’ (no clinical features of acromegaly and normal IGF1). Of the 100 consecutive pituitary adenomas, 29% were gonadotroph/glycoprotein, 24% somatotroph, 18% null cell, 15% corticotroph, 6% lactotroph, 2% thyrotroph, and 6% not classifiable. Of the 24 patients with somatotroph adenomas, classic accounted for 45.8%, subtle 16.7%, clinically silent 33.3%, and silent 4.2%. Clinically silent somatotroph adenomas are more common than previously appreciated, representing one-third of all somatotroph adenomas. IGF1 should be measured in all patients with a sellar mass, because identification of a mass as a somatotroph adenoma expands the therapeutic options and provides a tumor marker to monitor treatment.Keywords
This publication has 17 references indexed in Scilit:
- Monitoring of acromegaly: what should be performed when GH and IGF‐1 levels are discrepant?Clinical Endocrinology, 2009
- Clinically Silent Somatotropinomas May Be Biochemically ActiveJournal of Clinical Endocrinology & Metabolism, 2005
- Silent mixed corticotroph and somatotroph macroadenomas presenting with pituitary apoplexyActa Neuropathologica, 2001
- Morphological characterization and subtyping of silent somatotroph adenomas.Pituitary, 1999
- Endocrine and morphological study of a clinically silent somatotroph adenoma of the human pituitary.Journal of Clinical Endocrinology & Metabolism, 1993
- Somatotrpic Adenomas without AcromegalyPathology - Research and Practice, 1991
- Growth hormone excess and galactorrhoea without acromegalic features. Case reportsBJOG: An International Journal of Obstetrics and Gynaecology, 1991
- Silent somatotroph adenomas of the human pituitary. A morphologic study of three cases including immunocytochemistry, electron microscopy, in vitro examination, and in situ hybridization.1989
- Clinically silent hypersecretion of growth hormone in patients with pituitary tumorsJournal of Neurosurgery, 1987
- Somatotropic Adenoma Manifested by Galactorrhea without Acromegaly*Journal of Clinical Endocrinology & Metabolism, 1985