Table 1 Clinicopathological features of 25 patients with silent subtype 3 adenomas
Case | Patient age (years) and gender | Clinical presentation | Main biochemical findings (limit of normal reference interval) | Radiological features | Treatment | Surgical outcome and other therapy | Follow-up a (months) |
|---|---|---|---|---|---|---|---|
1 | 66, F | Headaches and right third cranial nerve palsy | PRL=28 μg/l (≤29.9), hypogonadism | Macroadenoma with suprasellar and downward growth as well as cavernous sinus invasion | TSS | Progressive residual tumor within the cavernous sinus | 9 |
2 | 17, F | Hyperthyroidism | TSH=1.14 mIU/l (<5), FT4=40 pmol/l (<23) | Not available | Surgery-surgical approach unknown | Resolution of hyperthyroidism | 70* |
3 | 53, F | Incidentaloma | PRL=91.1 μg/l (≤29.9), hypogonadism | Macroadenoma with suprasellar and downward growth | TSS | Complete gross resection of the tumor without evidence of recurrence | 73 |
4 | 68, M | Headaches and nasal obstruction | GH=0.8 μg/l (≤9) IGF-1=264 μg/l (≤243) | Macroadenoma with predominant downward growth into the sphenoid sinus, erosion of the clivus, and cavernous sinus invasion | TSS | Residual tumor in the cavernous sinuses and throughout the clivus that progressed | 58 |
5 | 42, F | Visual field deficit | PRL=13.3 μg/l (≤29.9) | Giant adenoma with marked downward and suprasellar growth as well as cavernous sinus invasion | TCS | Residual sellar and infrasellar tumor that showed slow progression; hypopituitarism | 58 |
6 | 30, F | Secondary amenorrhea, galactorrhea, headaches and visual field deficit | PRL=67.4 μg/l (≤29.9), hypogonadism | Macroadenoma with predominant suprasellar extension, and downward growth | TSS | Complete gross resection with recovery of gonadal function and normalization of prolactin | 41 |
7 | 47, F | Incidentaloma | PRL=87.3 μg/l (≤29.8), GH<0.3 μg/l (≤9), IGF-1=96 μg/l (178–295) | Macroadenoma with predominant downward growth and suprasellar extension | TSS | Residual tumor | 5 |
8 | 13, M | Progressive bilateral temporal visual field loss | PRL=10.6 μg/l | Macroadenoma with predominant suprasellar growth, symmetric downward remodeling of the sella, and cavernous sinus invasion | TCS followed by TSS | Suprasellar component of residual tumor was removed at second surgery; hypopituitarism with cavernous sinus disease | 44 |
9 | 28, F | Irregular menses; PHPT and MEN-1 mutation discovered during course of investigations | PRL=45.2 μg/l (<24) | Macroadenoma with suprasellar growth | TSS | Complete gross resection and no evidence of recurrence; resolution of menstrual irregularities and hyperprolactinemia | 46 |
10 | 19, F | Unknown | PRL=13 μg/l (<24), normal thyroid function tests | Non-invasive macroadenoma without parasellar extension | TSS | Complete gross resection and no evidence of recurrence | 39 |
11 | 68, M | Headaches | PRL 13.1 μg/l (≤18.1) | Macroadenoma with predominant suprasellar growth and cavernous sinus invasion | TSS | Residual tumor within the sella and cavernous sinus with mild progression of the intrasellar component | 14 |
12 | 69, F | Hyperthyroidism | TSH=4.67 mIU/l (≤5), FT4=27 pmol/l (≤23), PRL=6.1 μg/l (≤24) | Macroadenoma with mild suprasellar growth | TSS | Resolution of hyperthyroidism | 1* |
13 | 44, M | Chronic headaches and visual field defects followed by pituitary apoplexy; left cranial sixth nerve palsy | PRL=18.2 μg/l (≤17.7), hypogonadism, adrenal insufficiency | Macroadenoma with marked downward and suprasellar growth | TSS | Lack of recovery of pituitary function; residual tumor progressed slightly inferiorly and invaded the cavernous sinus | 103 |
14 | 43, M | Fatigue associated with central hypogonadism | PRL=5.1 μg/l (≤13.1) LH described as ‘inappropriately low’ Free testosterone=10.2 pmol/l (≤15.8) | Macroadenoma with predominant suprasellar growth, and invasion into the clivus | TSS | Residual tumor that progressed | 55 |
15 | 75, F | Incidentaloma | PRL=11 μg/l (≤24) | Macroadenoma with suprasellar growth | TSS | Resection of suprasellar component with stable residual disease within the sella | 42 |
16 | 48, F | Visual field deficit | Unavailable—basal pituitary function tests were described as ‘normal’ | Postoperative MRI showed a macroadenoma with suprasellar and downward growth as well as cavernous sinus invasion | TSS and radiotherapy | Residual disease stabilized after radiation; visual field defects disappeared after surgery but she developed hypopituitarism | 171 |
17 | 38, M | Chronic headaches, decreased libido and weight loss followed by visual field deficit | PRL=48.4 μg/l (≤13.1), central hypogonadism and adrenal insufficiency | Macroadenoma with predominant suprasellar extension | TSSx2 | Lack of recovery of pituitary function and residual progressive disease that led to a second surgery in which tumor resection was also incomplete | 19 |
18 | 24, M | Visual field deficits | TSH=1.44, FT4=34 pmol/l (≤22), FT3 6.1 pmol/l ≤6.8), PRL 26 μg/l (≤20) | Macroadenoma with suprasellar extension | TSSx2 | Residual disease with hyperthyroidism persisted after first surgery; biochemical improvement after second surgery | 12* |
19 | 40, M | Visual field deficit and hypogonadism | LH=2 IU/l (≤9), total testosterone=6.2 nmol/l (≥7.6), PRL =14.3 μg/l (≤31.1) | Macroadenoma with predominant suprasellar extension | TSS | Lack of recovery of pituitary function; complete gross resection of the tumor with recovery of peripheral vision | 7 |
20 | 53, F | Headaches and fatigue with acromegalic features on physical examination | GH=9.2 μg/l (≤9), IGF-1=703 μg/l (≤295), nonsuppressible GH during OGTT, PRL=15.2 μg/l (≤29.9), | Macroadenoma with predominant downward growth with bone erosion and complete infiltration of the clivus; also suprasellar extension and invasion of the cavernous sinus | TSS | Residual tumor and lack of improvement of growth hormone excess | 7* |
21 | 34, F | Longstanding amenorrhea, galactorrhea, headaches and visual field defects; MEN-1 diagnosis rendered during course of investigations because of finding of PHPT and pancreatic tumors | PRL=332 μg/l (≤26.7) IGF-1 100 μg/l (182–481), GH<0.3 μg/l (≤9.9), hypogonadism | Giant adenoma with suprasellar extension and downward invasion into the sphenoid sinus; cavernous sinus invasion | Dopamine agonist for several years followed by TSS and radiotherapy | Residual tumor that was treated with radiotherapy | 4 |
22 | 55, M | Headaches, increase in ring and shoe size, joint pain, visual field deficits | GH=3 μg/l (≤0.9), IGF-1=884 μg/l (≤295), PRL=7.9 μg/l (≤18.1), hypogonadism | Macroadenoma with predominant downward growth and remodeling of the clivus | TSS | Complete gross resection with gradual decrease in IGF-1 levels and GH suppression on OGTT | 10 |
23 | 31, F | Headaches, visual field deficits | PRL=28 μg/l (≤24) | Macroadenoma with predominant suprasellar growth and mild downward growth | TSSx2 | Complete gross resection after the second surgery; hypopituitarism | 139 |
24 | 52, M | Headaches and hyperthyroidism | TSH=6.9 mIU/l (≤5), FT4=29 pmol/l (≤25), FT3=3.6 nmol/l (≤2.7) PRL=3 μg/l (≤13) | Macroadenoma with predominant suprasellar growth and downward growth with marked remodeling | TSS | Stable residual tumor with resolution of central hyperthyroidism and development of central hypothyroidism | 119 |
25 | 35, F | Incidentaloma | PRL=4.5 μg/l (≤24) | Macroadenoma with predominant suprasellar growth and mild downward remodeling | TSS | Complete gross resection | 7 |
