Zhang Keyi, Shou Xuefei, Chen Hong, Qiao Nidan, He Wenqiang, Chen Zhengyuan, Shen Ming, Li Shiqi, Zhao Yao, Zhang Zhaoyun, Li Yiming, Ye Hongying, Wang Yongfei
Department of Neurosurgery, Shanghai Huashan Institute of Neurological Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China.
Department of Pathology, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China.
Front Endocrinol (Lausanne). 2021 Jan 18;11:608691. doi: 10.3389/fendo.2020.608691. eCollection 2020.
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.
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.
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).
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).
探讨促肾上腺皮质激素（ACTH）免疫染色阳性与阴性的无功能促肾上腺皮质激素腺瘤（SCA）的不同临床特征，并探讨垂体限制性转录因子（Tpit）免疫染色对SCA诊断的价值。
回顾性分析2018年4月至2019年3月在本中心就诊的具有典型病理特征、Tpit免疫染色阳性且ACTH免疫染色阳性/阴性、无库欣综合征临床特征及生化证据的SCA患者的临床资料。探讨ACTH阳性与阴性SCA患者临床特征及手术结果的差异。
共纳入105例SCA患者（94.3%为女性）。其中ACTH阴性SCA 66例（66/105，62.9%），ACTH阳性SCA 39例（39/105，37.1%）。ACTH阴性SCA患者的ACTH水平更低（27.5±24.0 vs. 54.4±58.6，P = 0.011），多发微囊肿更多（81.8% vs. 61.5%，P = 0.022），Ki-67表达水平更低（低表达率90.9% vs. 74.4%，P = 0.023）。ACTH阳性与阴性SCA患者在性别（97.0% vs. 89.7%，P = 0.192）、年龄（50.3±10.3 vs. 49.0±11.2，P = 0.543）、手术史（16.7% vs. 23.1%，P = 0.419）、鞍上扩展（66.7% vs. 74.4%，P = 0.408）、蝶窦扩展（51.5% vs. 56.4%，P = 0.627）、海绵窦侵犯（75.8% vs. 66.7%，P = 0.314）、磁共振成像（MRI）上大囊肿（47.0% vs. 61.5%，P = 0.149）或全切率（42.4% vs. 51.3%，P = 0.379）方面未观察到统计学显著差异。
ACTH阴性SCA在临床上更隐匿，MRI上更易表现为多发微囊肿。SCA的患病率，尤其是ACTH阴性SCA，被证实被严重低估，鉴于这种难治性垂体腺瘤（PA）亚型的高侵袭性，应给予足够重视。
