Poster Presentation ESA-SRB-ANZOS 2025 in conjunction with ENSA

Silent Macrocorticotrophinomas – Whispering Trouble or Just Background Noise? (128570)

Judy Chen 1 2 , George Rudd 3 , Davide Galdiolo  4 5 , Romane Thiboutot-Martin 4 , Olivia Beatty 4 , Antonio Di Ieva 3 , Veronica Preda 2 4
  1. Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, Australia
  2. Department of Endocrinology, Macquarie University Hospital, Macquarie University, NSW, Australia
  3. Macquarie Neurosurgery & Spine, Macquarie University Hospital, Macquarie University, NSW, Australia
  4. Faculty of Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, NSW, Australia
  5. Department of Medicine and Surgery, University of Pavia, Pavia, Italy

Silent corticotroph adenomas (SCAs) are considered an aggressive subtype of pituitary neuroendocrine tumour and are thought to differ from other non-functioning pituitary neuroendocrine tumours (pitNET), with reports of higher recurrence rates following surgical resection. Our aim was to compare long-term surgical outcomes in patients with SCAs and other pitNETs requiring resection.

We conducted a retrospective cohort study of patients who underwent surgical resection of pitNETs at a tertiary hospital in metropolitan Sydney between June 2010 and June 2025. All participants were managed through a multidisciplinary service and had histopathological confirmation of pitNET. Surgery was indicated for tumour growth or mass effect, including optic apparatus involvement and/or cavernous sinus invasion.

Fifty-seven patients were included, with a mean follow-up of 82.7±48.5months. Nine experienced tumour recurrence (mean time to recurrence 42.8±34.7 months). Age at surgery was similar between recurrence and non-recurrence groups (50.9±15.4 vs. 54.0±13.6  years; p=0.59). Tumour size trended larger in the recurrence group (28.0±9.8mm vs. 24.2±7.0mm; p=0.29).

Gross total resection was significantly associated with long-term remission (75% vs. 11%; p<0.003), while subtotal resection predicted recurrence (88% vs. 25%; p<0.003), despite more frequent use of postoperative radiotherapy in those with recurrence (56% vs. 8%; p<0.003). SCAs were not overrepresented in the recurrence group (1/9 vs. 10/48; p=0.49). Presentation with visual disturbance was significantly more common in those with recurrence (78% vs. 23%; p=0.0012), although there were no significant differences in formal perimetry or ganglion nerve fibre layer analyses. There was no significant difference in Knosp grades between recurrent and non-recurrent tumours. Rates of optic chiasm compression, cavernous sinus , sphenoid sinus and/or clival invasion were similar across groups.

Tumour recurrence after pitNET resection was strongly associated with subtotal resection and initial visual symptoms. Tumour size, subtype (including SCA), and invasive features did not significantly differ between those with and without recurrence.