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Clin Endocrinol (Oxf). 2014 Oct;81(4):566-72. doi: 10.1111/cen.12443. Epub 2014 May 5.

Silent, but not unseen: multimicrocystic aspect on T2-weighted MRI in silent corticotroph adenomas.

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1
Department of Endocrinology, CHU Ambroise Pare, Assistance Publique Hôpitaux de Paris, Boulogne, France; EA 2493, Versailles Saint Quentin University, Montigny-le-Bretonneux, France.

Abstract

OBJECTIVE:

Silent corticotroph adenomas (SCAs) present as nonfunctional pituitary tumours in routine pre-operative evaluation. The objective of this study was to evaluate the diagnostic accuracy of MRI T2-weighted sequences for detecting the corticotroph subtype pre-operatively.

DESIGN:

The pre-operative T2-weighted MRI sequences were retrospectively evaluated in patients with SCA and two control groups: clinically manifest corticotroph macroadenomas (CSMs) and nonfunctional gonadotroph macroadenomas (NFGMs). All were selected from a registry of 1096 patients in whom transsphenoidal surgery was performed in the same tertiary reference centre. T2-weighted MRI sequences were independently classified by one senior endocrinologist and one senior radiologist who were blinded to the clinical and histological features.

PATIENTS:

Seventeen patients with SCA, 14 with CSM and 60 with NFGM were included in this study.

MEASUREMENTS:

Pituitary MRI with T2-weighted sequences. Two aspects were retained: multiple microcysts (MMs) and the absence of microcysts. Hormonal data included plasma prolactin, IGF-1, testosterone or oestradiol, LH, FT4, TSH, morning plasma cortisol and an ACTH-stimulation test, when available.

RESULTS:

Multiple microcysts were present in 76% (13/17) of SCAs, 21% (3/14) of CSMs and 5% (3/60) of NFGMs. The presence of MMs in clinically nonfunctioning macroadenomas had a sensitivity of 76% and a specificity of 95% for predicting SCA.

CONCLUSION:

The presence of MMs in T2-weighted MRI is a good diagnostic tool to suggest the corticotroph subtype in an apparently nonfunctional pituitary tumour.

PMID:
24601912
DOI:
10.1111/cen.12443
[Indexed for MEDLINE]
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