Abstract
Context
Silent pituitary adenomas are anterior pituitary tumors with hormone synthesis but without signs or symptoms of hormone hypersecretion. They have been increasingly recognized and represent challenging diagnostic issues.
Evidence Acquisition
A comprehensive literature search was performed using MEDLINE and EMBASE databases between January 2000 and March 2018 with the following key words: (i) pituitary adenoma/tumor and non-functioning; or (ii) pituitary adenoma/tumor and silent. All titles and abstracts of the retrieved articles were reviewed and recent advances in the field of silent pituitary adenomas were summarized.
Evidence Synthesis
The clinical and biochemical picture of pituitary adenomas reflects a continuum between functional and silent adenomas: while some adenomas are truly silent, others may show some evidence of biochemical hypersecretion or may have subtle clinical signs, and therefore may be referred to as clinically silent or ‘whispering’ adenomas. Silent tumors seem to be more aggressive than their secreting counterparts, with a higher rate of recurrence. Transcription factors for pituitary cell lineages have been introduced into the 2017 WHO guidelines: SF1 staining for gonadotroph lineage, PIT1 for growth hormone, prolactin and TSH lineage, and TPIT for the corticotroph lineage. Prospective studies applying these criteria will establish the value of the new classification.
Conclusions
A concise review of the clinical and pathological aspects of silent pituitary adenomas was conducted in view of the new WHO classification of pituitary adenomas. New classifications, novel prognostics markers, emerging imaging and therapeutic approaches will need to be evaluated to better serve this unique group of patients.
Silent pituitary adenomas are anterior pituitary tumors with hormone synthesis but without signs or symptoms of hormone hypersecretion. They have been increasingly recognized and represent challenging diagnostic issues.
Evidence Acquisition
A comprehensive literature search was performed using MEDLINE and EMBASE databases between January 2000 and March 2018 with the following key words: (i) pituitary adenoma/tumor and non-functioning; or (ii) pituitary adenoma/tumor and silent. All titles and abstracts of the retrieved articles were reviewed and recent advances in the field of silent pituitary adenomas were summarized.
Evidence Synthesis
The clinical and biochemical picture of pituitary adenomas reflects a continuum between functional and silent adenomas: while some adenomas are truly silent, others may show some evidence of biochemical hypersecretion or may have subtle clinical signs, and therefore may be referred to as clinically silent or ‘whispering’ adenomas. Silent tumors seem to be more aggressive than their secreting counterparts, with a higher rate of recurrence. Transcription factors for pituitary cell lineages have been introduced into the 2017 WHO guidelines: SF1 staining for gonadotroph lineage, PIT1 for growth hormone, prolactin and TSH lineage, and TPIT for the corticotroph lineage. Prospective studies applying these criteria will establish the value of the new classification.
Conclusions
A concise review of the clinical and pathological aspects of silent pituitary adenomas was conducted in view of the new WHO classification of pituitary adenomas. New classifications, novel prognostics markers, emerging imaging and therapeutic approaches will need to be evaluated to better serve this unique group of patients.
| Original language | English |
|---|---|
| Journal | The Journal of Clinical Endocrinology & Metabolism |
| Early online date | 17 Jul 2018 |
| DOIs | |
| Publication status | Published - 2019 |
