Subclinical hyperfunctioning pituitary adenomas: the silent tumors

Abstract

Pituitary adenomas are classified by function as defined by clinical symptoms and signs of hormone hypersecretion with subsequent confirmation on immunohistochemical staining. However, positive immunostaining for pituitary cell types has been shown for clinically nonfunctioning adenomas, and this entity is classified as silent functioning adenoma. Most common in these subtypes include silent gonadotroph adenomas, silent corticotroph adenomas and silent somatotroph adenomas. Less commonly, silent prolactinomas and thyrotrophinomas are encountered. Appropriate classification of these adenomas may affect follow-up care after surgical resection. Some silent adenomas such as silent corticotroph adenomas follow a more aggressive course, necessitating closer surveillance. Furthermore, knowledge of the immunostaining characteristics of silent adenomas may determine postoperative medical therapy. This article reviews the incidence, clinical behavior, and pathologic features of clinically silent pituitary adenomas.

Figure 1

Model for development of human anterior pituitary cell lineage determination by a temporally controlled cascade of transcription factors. Trophic cells are depicted with transcriptions factors known to determine cell-specific human or murine gene expression. Adapted with permission from S. Melmed, J. Clin. Invest. 112:1603–1618 (2003). doi:10.1172/JCI200320401.