• Journal of Korean Neurosurgical Society
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• v.40 no.5
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• pp.330-335
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• 2006

Objective : The aim of the study was to review the clinical and radiological findings of those non-functioning adenomas[NFAs] with positive immnoreactivity for anterior pituitary hormones. Methods : Sixty patients with pituitary adenoma were treated at the author's institution between January 2000 and July 2005. All consecutive patients were underwent transsphenoidal surgery by same operator. In addition to the routine histopathological examination, surgical specimen was examined by immunohistochemical staining against adenohypophyseal cells. And clinical analysis was performed by retrospective review of medical records, neuroimaging examinations and immunohistochemical technique. We classified these pituitary adenomas into functioning adenomas [group F], immuno-positive NFAs [group S, so-called silent adenoma] and immuno-negative NFAs [group N], and compared clinical and radiological differences between group F, N, and S. Results : Of the 60 cases, group F was 25, group S was 25, and group N was 10. Among the group S, 5 cases showed reactivity against PRL, 1 against GH, 1 against both PRL and GH, 1 against TSH and GH, 2 against ACTH, 11 against FSH and 4 against both LH and FSH. Radiologically, invasiveness was noted in 8 in group S, compared to 3 in group N and 1 in group F [p = 0.02]. Intratumoral bleeding was noted in 7 of group S, 2 of group N and 2 of group F [p >0.05]. Conclusion : Silent adenomas were thought to behave more aggressive than other subgroups of pituitary adenomas. And so we suggest the immunohistochemical study against adenohypophyseal cells may be helpful for evaluating clinical course of pituitary adenoma, expecially for, NFAs.

• Journal of Korean Neurosurgical Society
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• v.46 no.1
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• pp.23-30
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• 2009

Objective : Clinical features of pituitary hemorrhage vary from asymptomatic to catastrophic. The purpose of this study was to evaluate the factors related to severity of hemorrhage of pituitary adenoma. Methods : Pituitary hemorrhage was noted in 32 of 88 patients who underwent operations between January 2000 and December 2007. Clinical status was classified into group I (no hemorrhage symptoms), II (mild to moderate symptoms without neurological deficit), and III (with neurological deficit), and was compared to radiological, pathological, and operative findings. All patients were operated by transsphenoidal approach, and hemorrhage-related symptoms were relieved. Results : Groups I, II,and III comprised 15, 10 and 7 patients, respectively. In group I, hemorrhage volume was under 1 mL in 11 (73.3%), but, it was above 1 mL in 7 (70%) of group II and in all cases of group III. Hemorrhage stage based on MRI findings was chronic or subacute in 11 (73.3%) of group I, acute in 6 (60%) of group II, and acute or hyperacute in 6 (85.7%) of group III. Pathological examination revealed chronic-stage hematomas in 5 (50%) group II patients. Functioning adenomas were found in 5 (33.3%) group I patients but none in group II or III patients. Silent adenomas were found in 4 (26.7%), 8 (80%), and 3 (42.9%) in groups I, II,and III, respectively. Conclusion : Clinical features of pituitary hemorrhage may differ with the radiological and immunohistopathlogical findings. Persistent symptoms are related to the chronic stage of hematoma requiring surgery for symptom relief. Neurological deficits are caused by large amount of acute hemorrhage requiring emergency operation. Silent adenoma is related to the severity of pituitary hemorrhage.

• Journal of Korean Neurosurgical Society
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• v.62 no.1
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• pp.114-122
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• 2019

Objective : Silent corticotroph adenomas (SCA) are endocrine-inactive pituitary adenomas with positive immunohistochemistry staining for adrenocorticotropic hormone (ACTH). We investigated whether SCA-associated clinical profiles were more aggressive than hormonally negative adenomas (HNA). Methods : Among 627 patients with pathologically proven endocrine-inactive pituitary adenomas between 2004 and 2013, positive immunohistochemistry revealed 55 SCAs and 411 HNAs. Surgical outcomes and radiological and endocrinological characteristics were compared. Results : Strong female predominance was observed in the SCA group (p<0.001). Cavernous sinus invasion was identified in 22 (40%) SCA patients and 72 (17.6%) HNA patients (p<0.001). There were no differences in ACTH or cortisol levels between the two groups. The incidence of preoperative hypopituitarism and postoperative hormonal outcome did not differ between two groups. Total resection was achieved in 35 patients (63.7%) with SCA and 332 patients (80.8%) with HNA (p=0.007). When tumors were completely removed, recurrence rates were not statistically different between two groups (p=0.60). When complete resection was not achieved, tumors regrew from these remnants in seven patients (35.0%) with SCA and 12 patients (15.2%) with HNA (p=0.05). Conclusion : Total surgical resection for SCA is often challenging as these tumors frequently invade a cavernous sinus. Early remnant tumor intervention is justified, because untreated residual pituitary tumors regrow when patients were followed up for a long time. Prophylactic radiotherapy is not warranted for completely resected SCAs as tumor recurrence is uncommon.