Silent Corticotroph Pituitary Adenoma

Silent corticotroph pituitary adenomas are pituitary adenomas that require special attention. They are clinically and biologically silent but harbor ACTH-secreting cells at pathology. They may convert into active adenoma responsible for Cushing disease. Because they are endocrinologically silent, silent corticotroph adenomas are usually diagnosed when large and behave like nonfunctioning macroadenomas, being responsible for headaches, visual impairment, or pituitary deficiency (Fig. 16.1). Hemorrhage and apoplexy may be more prevalent that in nonfunctioning adenomas and ACTH-secreting adenomas (Fig. 16.2). Silent corticotroph adenomas can recur easily (Fig. 16.3), and present as aggressive tumors with frequent invasion of the cavernous sinus. Surgical treatment may fail, thus leading to different trials of multimodal therapy, including stereotactic radiosurgery, somatostatin analogs, and chemotherapy such as temozolomide.