This article is more than 5 years old. Information may no longer be current.
Basal cortisol elevated in patients with ACTH-staining pituitary macroadenoma
Click Here to Manage Email Alerts
AUSTIN, Texas — Preoperative identification of patients with silent adrenocorticotrophic hormone-secreting tumors could potentially change the approach to management. A new study aimed to determine whether a preoperative adrenocorticotrophic hormone stimulation test for evaluation of nonfunctional pituitary macroadenoma could aid in identifying adrenocorticotrophic hormone-staining pathology yielded large variability and did not allow clinical utility.
Thus, researchers concluded that larger, multicenter research is needed to determine whether this test can be useful.
“As ACTH stimulation tests are performed routinely when evaluating macroadenoma when there is no suspicion for a state of endogenous hypercortisolism, we sought to determine if the test could reliably identify these pathologies during the preoperative evaluation. We hypothesized that patients with subclinical Cushing’s disease or silent ACTH-secreting tumors would have a higher delta cortisol on the ACTH stimulation tests vs. other types of macroadenoma pathologies,” Kevin Pantalone, DO, ECNU, FACE, staff endocrinologist and director of clinical research in the department of endocrinology at Cleveland Clinic, told Endocrine Today.
Pantalone and colleagues performed a retrospective chart review of 148 patients with pituitary macroadenoma who underwent preoperative ACTH stimulation tests, with the goal of determining whether the test can aid in the identification of ACTH-staining pathology.
Overall, 9.5% of patients showed diffuse staining, 50.6% showed other-staining (diffuse staining for anterior pituitary hormones other than ACTH) and 39.9% showed no staining (no staining for any anterior pituitary hormones).
The researchers calculated delta total cortisol at 30 and 60 minutes from baseline and reviewed preoperative ACTH stimulation tests. Additionally, Pantalone and colleagues compared the basal and maximal delta cortisol between the ACTH-staining pituitary macroadenoma and the non-ACTH staining (n = 134), other staining (n = 75) and non-staining (n = 59) tumors.
According to data reported at the American Association of Clinical Endocrinologists Annual Scientific and Clinical Congress, the ACTH-staining group had higher mean basal cortisol levels compared with the non-ACTH-staining (P = .012), other staining (P = .018) and the non-staining (P = .012) tumors. The researchers found no significant differences in maximal delta cortisol between the groups.
“While we found basal cortisol levels were higher in patients with ACTH-staining pituitary microadenoma vs. non-ACTH-staining macroadenoma, the large variability in cortisol values did not allow for clinical utility,” Pantalone told Endocrine Today.
“Unfortunately, in the end, our study was limited by the number of cases with ACTH-staining pathology. Thus, we were unable to determine if the ACTH stimulation test could reliably assist clinicians in potentially identifying ACTH-staining pathology in the preoperative setting,” he said. “A multicenter study, affording a large number of ACTH-staining tumors, is needed. This may allow for us to determine if the ACTH-stimulation test can really be clinically useful in preoperatively identifying ACTH-staining pathology.” – by Amber Cox
Reference:
Polanco Santos C, et al. Abstract #818. Presented at: AACE Annual Scientific and Clinical Congress; May 3-7, 2017; Austin, Texas.
Disclosure: Pantalone reports no relevant financial disclosures.
Perspective
Back to Top
Ricardo Correa, MD, FACP
The study by Polanco Santos and colleagues is a research study that evaluated the value of preoperative ACTH stimulation testing in nonfunctioning macroadenoma. There are many limitations in the study including: retrospective analysis, poor sample size, no standardized cortisol assay and others. The authors couldn’t probe their hypothesis, which was that ACTH stimulation testing is predictive of ACTH staining in nonfunctioning pituitary macroadenomas. At this point, this abstract … will not change the standard clinical management of nonfunctioning pituitary adenomas. Right now, in the clinical setting, we don’t use routine ACTH stimulation tests before surgery for nonfunctional pituitary adenomas. This study reinforces that knowledge. I agree with the authors that to probe the hypothesis properly that the sample size needs to increase and a multicenter trial will be very helpful. Sincerely, I doubt that in a larger study anything will be found due to the physiopathology of the nonfunctioning pituitary adenoma, but it is valuable to investigate it. The study has to be planned very carefully and all confounding bias should be taking into consideration.
Click Here to Manage Email Alerts