A clinicoradiological analysis of silent corticotroph adenomas after the introduction of pituitary-specific transcription factors

Background Silent corticotroph adenomas (SCAs) are a rare subtype of non-functional pituitary adenoma. While it has been suggested that they are more aggressive and recur more frequently following excision, there is limited literature on the optimum treatment strategy for these tumors, especially regarding the role of radiation therapy in incompletely resected tumors. Method We assimilated data from 62 SCAs and 238 other non-functional adenomas (ONAs), defined according to the WHO 2017 criteria that incorporates transcription factor analysis. We compared their clinicoradiological characteristics, such as hormonal levels, tumor configuration, size, and invasiveness. For 52 SCAs and 205 ONAs with serial follow-up imaging, we studied outcomes for progression after subtotal resection with or without radiation therapy or recurrence after gross total resection. Kaplan Meier analysis for recurrence or progression was used to determine the need for a differential treatment strategy for SCAs compared with other non-functional adenomas specifically concerning the role of radiotherapy. Results Patients with SCAs present at a younger age than ONAs (43.9 years vs. 48.2 years, p = 0.014) , with larger (14.9 cc vs. 9.7 cc , p = 0.006 ) and more invasive adenomas (61.2% vs. 45.8%, p = 0.021 ). Overall, SCAs are more likely to recur or progress (48.7 vs. 15.7%, p