Clinical, radiological, and pathological characteristics and long-term outcomes of silent corticotroph adenomas: a...

Silent corticotroph adenomas (SCAs), a subtype of non-functioning pituitary adenomas (NFPAs), exhibit aggressive biological behaviour despite the absence of clinical hormone hypersecretion. This study aimed to identify preoperative predictors of SCAs and evaluate prognostic factors for postoperative recurrence in both NFPAs and SCAs.

We retrospectively analysed 192 patients with NFPAs who underwent transsphenoidal surgery between 2014 and 2019. Clinical presentation, imaging findings, pathological characteristics, surgical outcomes, and recurrence data were compared. Logistic regression and receiver operating characteristic analyses were used to identify predictors of SCAs. Recurrence-free survival was assessed using Kaplan-Meier analysis, and Cox regression was applied to determine independent prognostic factors.

SCAs were more frequent in female patients and were associated with visual impairment, multiple microcysts, and sellar floor invasion (all p < 0.01). Logistic regression identified these factors as independent predictors, with an area under the curve (AUC) of 0.802. During a median follow-up of 53.5 months, the recurrence rate was significantly higher in the SCA group than in the non-SCA group (40.9% vs. 19.6%; p = 0.004). In NFPAs, Knosp grade ≥ 3, Ki-67 ≥ 3%, and subtotal resection (STR) were independent risk factors for recurrence. In SCAs, only Ki-67 ≥ 3% (hazard ratio [HR] = 5.122; p = 0.004) and STR (HR = 3.273; p = 0.018) remained significant.

SCAs are a biologically aggressive subtype of NFPA with distinct clinicopathological features. Reliable preoperative indicators and recognition of recurrence risk factors is essential to guide early diagnosis, close surveillance, and individualised treatment to improve long-term outcomes.

Not applicable.