====== Silent pituitary neuroendocrine tumor ======

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In [[the 2022 World Health Organization classification of tumors of the pituitary gland]], nonfunctioning PitNETs are classified according to their frequency as [[silent gonadotroph tumor]]s, [[silent corticotroph tumor]]s, [[silent immature PIT1-lineage tumor]]s, [[null cell tumor]]s, and other tumors 
((Wan XY, Chen J, Wang JW, Liu YC, Shu K, Lei T. Overview of the [[2022]] WHO Classification of Pituitary Adenomas/Pituitary Neuroendocrine Tumors: Clinical Practices, Controversies, and Perspectives. Curr Med Sci. 2022 Dec;42(6):1111-1118. doi: 10.1007/s11596-022-2673-6. Epub 2022 Dec 22. PMID: 36544040.))
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[[Pituitary neuroendocrine tumor]]s are stratified into [[functional]] or [[silent]] categories based on their pattern of [[hormone]] expression and [[secretion]]. Preliminary evidence supports differential clinical outcomes between some functional [[Pituitary neuroendocrine tumor]] subtypes and silent [[Pituitary neuroendocrine tumor]] subtypes.

Gupta et al. collected and analyzed the [[medical record]]s of all patients undergoing resection of Functional or Silent from a single high-volume neurosurgeon between [[2007]] and [[2018]] at Brigham and Women's Hospital. Descriptive statistics and the Mantel-Cox log-rank test were used to identify differences in outcomes between these cohorts, and multivariate logistic regression was used to identify predictors of radiographic recurrence for SPAs.

The cohort included 88 SPAs and 200 FPAs. The majority of patients in both cohorts were female (48.9% of SPAs and 63.5% of FPAs). SPAs were larger in median diameter than FPAs (2.1 cm vs. 1.2 cm, p < 0.001). The most frequent subtypes of SPA were gonadotrophs (55.7%) and corticotrophs (30.7%). Gross total resection (GTR) was achieved in 70.1% of SPA resections and 86.0% of FPA resections (p < 0.001). SPAs had a higher likelihood of recurring (hazard ratio [HR] 3.2, 95% confidence interval [95%CI] 1.6-7.2) and a higher likelihood of requiring retreatment for recurrence (HR 2.5; 95%CI 1.0-6.1). Subset analyses revealed that recurrence and retreatment were more likely for subtotally resected SPAs than subtotally resected FPAs, but this pattern was not observed in SPAs and FPAs after GTR. Among SPAs, recurrence was associated with STR (odds ratio [OR] 9.3; 95%CI 1.4-64.0) and younger age (OR 0.92 per year; 95%CI 0.88-0.98) in multivariable analysis. Of SPAs that recurred, 12 of 19 (63.2%) were retreated with repeat surgery (n = 11) or radiosurgery (n = 1), while the remainder were observed (n = 7). There were similar rates of recurrence across different SPA subtypes.

Patients undergoing resection of SPAs should be closely monitored for disease recurrence through more frequent clinical follow-up and diagnostic imaging than other adenomas, particularly among patients with STR and younger patients. Several patients can be observed after radiographic recurrence, and the decision to retreat should be individualized. Longitudinal clinical follow-up of SPAs, including an assessment of symptoms, endocrine function, and imaging remains critical
((Gupta S, Hoffman SE, Mehta NH, Hauser B, Altshuler M, Bernstock JD, Smith TR, Arnaout O, Laws ER. Elevated risk of recurrence and retreatment for silent pituitary adenomas. Pituitary. 2024 Feb 12. doi: 10.1007/s11102-024-01382-3. Epub ahead of print. PMID: 38345720.)).