The silent corticotropinoma: is clinical diagnosis possible?

B. Ambrosi, P. Colombo, D. Bochicchio, M. Bassetti, B. Masini, G. Faglia

Research output: Contribution to journalArticle

Abstract

Up to now, the diagnosis of silent corticotropin cell pituitary adenomas has been made only on histopathological basis. In this paper we describe 6 women affected with pituitary adenomas, without evident clinical features of hypercortisolism, in whom retrospective data suggested the possibility of clinically diagnosing silent corticotropinomas in vivo. In all patients basal ACTH and Cortisol levels were normal, and the low-dose dexamethasone test constantly suppressed serum Cortisol and urinary 17-hydroxycorti-costeroid levels. The CRH and/or lysine-vasopressin tests, performed in five patients, always induced exaggerated ACTH/cortisol rises. In three cases the response to the opiate agonist loperamide was assessed and no inhibition of ACTH/cortisol levels was found. All patients underwent pituitary surgery. In five cases evidence of corticotropinoma was obtained by immunohistochemistry or immunofluorescence studies; moreover, in one adenoma ACTH was secreted into the culture medium, and in another one CRH and arginine-vasopressin induced a marked intracellular [Ca++] rise. Electron microscopy study of the adenoma, removed from three patients, showed the presence of adenomatous corticotropin cells. Finally, in another woman no hormonal abnormalities were initially observed and she was operated for a “nonfunctioning” pituitary adenoma, but four years later an overt Cushing’s disease appeared, suggesting that a silent corticotropinoma subsequently became functional, although the formation of a different adenoma cannot be excluded. In conclusion, the occurrence of ACTH/cortisol hyperresponsiveness to CRH and/or lysine-vasopressin and the lack of suppression of ACTH/cortisol secretion to opioid agonists in patients with apparently “nonfunctioning” pituitary tumors might allow the in vivo recognition of silent corticotropinomas.

Original languageEnglish
Pages (from-to)443-452
Number of pages10
JournalJournal of Endocrinological Investigation
Volume15
Issue number6
DOIs
Publication statusPublished - 1992

Keywords

  • ACTH
  • corticotropinoma
  • Cushing’s disease
  • dexamethasone
  • immunohisto-chemistry
  • loperamide
  • opioids
  • Pituitary adenoma

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Fingerprint Dive into the research topics of 'The silent corticotropinoma: is clinical diagnosis possible?'. Together they form a unique fingerprint.

  • Cite this