{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T13:45:44Z","timestamp":1790430344923,"version":"4.1.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Nonfunctioning pituitary adenomas present without biochemical or clinical signs of hormone excess and are the second most common type of pituitary adenomas. The 2017 WHO classification scheme of pituitary adenomas differentiates null-cell adenomas (NCAs) and silent gonadotroph adenomas (SGAs). The present study sought to highlight the differences in patient characteristics and clinical outcomes between NCAs and SGAs.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The records of 1166 patients who underwent transsphenoidal surgery for pituitary adenoma between 2012 and 2019 at a single institution were retrospectively reviewed. Patient demographics and clinical outcomes were collected.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Of the overall pituitary adenoma cohort, 12.8% (n = 149) were SGAs and 9.2% (n = 107) NCAs. NCAs were significantly more common in female patients than SGAs (61.7% vs 26.8%, p < 0.001). There were no differences in patient demographics, initial tumor size, or perioperative and short-term clinical outcomes. There was no significant difference in the amount of follow-up between patients with NCAs and those with SGAs (33.8 months vs 29.1 months, p = 0.237). Patients with NCAs had significantly higher recurrence (p = 0.021), adjuvant radiation therapy usage (p = 0.002), and postoperative diabetes insipidus (p = 0.028). NCA pathology was independently associated with tumor recurrence (HR 3.64, 95% CI 1.07\u201312.30; p = 0.038), as were cavernous sinus invasion (HR 3.97, 95% CI 1.04\u201315.14; p = 0.043) and anteroposterior dimension of the tumor (HR 2.23, 95% CI 1.09\u20134.59; p = 0.030).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This study supports the definition of NCAs and SGAs as separate subgroups of nonfunctioning pituitary adenomas, and it highlights significant differences in long-term clinical outcomes, including tumor recurrence and the associated need for adjuvant radiation therapy, as well as postoperative diabetes insipidus. The authors also provide insight into independent risk factors for these outcomes in the adenoma population studied, providing clinicians with additional predictors of patient outcomes. Follow-up studies will hopefully uncover mechanisms of biological aggressiveness in NCAs and associated molecular targets.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2020.3.focus20114","type":"journal-article","created":{"date-parts":[[2020,6,3]],"date-time":"2020-06-03T08:21:59Z","timestamp":1591172519000},"page":"E13","source":"Crossref","is-referenced-by-count":39,"title":["Clinical characteristics and outcomes of null-cell versus silent gonadotroph adenomas in a series of 1166 pituitary adenomas from a single institution"],"prefix":"10.3171","volume":"48","author":[{"given":"Alexander F.","family":"Haddad","sequence":"first","affiliation":[{"name":"School of Medicine, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob S.","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taemin","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matheus P.","family":"Pereira","sequence":"additional","affiliation":[{"name":"School of Medicine, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rushikesh S.","family":"Joshi","sequence":"additional","affiliation":[{"name":"School of Medicine, University of California, San Diego;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn M.","family":"Pereira","sequence":"additional","affiliation":[{"name":"University of South Florida Morsani College of Medicine, Tampa, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Osorio","sequence":"additional","affiliation":[{"name":"School of Medicine, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Donohue","sequence":"additional","affiliation":[{"name":"School of Medicine, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain","family":"Peeran","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sweta","family":"Sudhir","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saket","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angad","family":"Beniwal","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley S.","family":"Chopra","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narpal S.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip V.","family":"Theodosopoulos","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Kunwar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan H.","family":"El-Sayed","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Gurrola","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis S.","family":"Blevins","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish K.","family":"Aghi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Histopathology","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1111\/his.13295","article-title":"What\u2019s new in pituitary pathology?","volume":"72","author":"Asa SL","year":"2018","unstructured":"Asa SL, Mete O: What\u2019s new in pituitary pathology? Histopathology 72:133\u2013141, 20182923903310.1111\/his.13295"},{"key":"b2","series-title":"Endocr Pathol","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s12022-014-9347-2","article-title":"Null cell adenomas of the pituitary gland: an institutional review of their clinical imaging and behavioral characteristics","volume":"26","author":"Balogun JA","year":"2015","unstructured":"Balogun JA, Monsalves E, Juraschka K, Parvez K, Kucharczyk W, Mete O, : Null cell adenomas of the pituitary gland: an institutional review of their clinical imaging and behavioral characteristics. Endocr Pathol 26:63\u201370, 201510.1007\/s12022-014-9347-225403448"},{"key":"b3","series-title":"Pituitary","first-page":"267","article-title":"Radically resected pituitary adenomas: prognostic role of Ki 67 labeling index in a monocentric retrospective series and literature review","volume":"17","author":"Chiloiro S","year":"2014","unstructured":"Chiloiro S, Bianchi A, Doglietto F, de Waure C, Giampietro A, Fusco A, : Radically resected pituitary adenomas: prognostic role of Ki 67 labeling index in a monocentric retrospective series and literature review. Pituitary 17:267\u2013276, 2014"},{"key":"b4","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"4769","DOI":"10.1210\/jc.2006-1668","article-title":"High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium","volume":"91","author":"Daly AF","year":"2006","unstructured":"Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A: High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab 91:4769\u20134775, 200610.1210\/jc.2006-166816968795"},{"key":"b5","series-title":"J Clin Endocrinol Metab","first-page":"168","article-title":"Pituitary tumor registry: a novel clinical resource","volume":"85","author":"Drange MR","year":"2000","unstructured":"Drange MR, Fram NR, Herman-Bonert V, Melmed S: Pituitary tumor registry: a novel clinical resource. J Clin Endocrinol Metab 85:168\u2013174, 200010634382"},{"key":"b6","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"2473","DOI":"10.1210\/jc.2018-00688","article-title":"Clinical and pathological aspects of silent pituitary adenomas","volume":"104","author":"Drummond J","year":"2019","unstructured":"Drummond J, Roncaroli F, Grossman AB, Korbonits M: Clinical and pathological aspects of silent pituitary adenomas. J Clin Endocrinol Metab 104:2473\u20132489, 20193002046610.1210\/jc.2018-00688"},{"key":"b7","series-title":"Radiother Oncol","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/j.radonc.2009.09.011","article-title":"Radiotherapy for pituitary adenomas: long-term efficacy and toxicity","volume":"93","author":"Erridge SC","year":"2009","unstructured":"Erridge SC, Conkey DS, Stockton D, Strachan MWJ, Statham PFX, Whittle IR, : Radiotherapy for pituitary adenomas: long-term efficacy and toxicity. Radiother Oncol 93:597\u2013601, 20091990072910.1016\/j.radonc.2009.09.011"},{"key":"b8","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"527","DOI":"10.3171\/2014.5.JNS131819","article-title":"Descriptive epidemiology of pituitary tumors in the United States, 2004\u20132009","volume":"121","author":"Gittleman H","year":"2014","unstructured":"Gittleman H, Ostrom QT, Farah PD, Ondracek A, Chen Y, Wolinsky Y, : Descriptive epidemiology of pituitary tumors in the United States, 2004\u20132009. J Neurosurg 121:527\u2013535, 20142492665010.3171\/2014.5.JNS131819"},{"key":"b9","series-title":"Endocr Pathol","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1007\/s12022-018-9563-2","article-title":"The prognostic roles of the Ki-67 proliferation index, P53 expression, mitotic index, and radiological tumor invasion in pituitary adenomas","volume":"30","author":"Hasanov R","year":"2019","unstructured":"Hasanov R, Aydo\u011fan B\u0130, Kiremit\u00e7i S, Erden E, G\u00fcll\u00fc S: The prognostic roles of the Ki-67 proliferation index, P53 expression, mitotic index, and radiological tumor invasion in pituitary adenomas. Endocr Pathol 30:49\u201355, 20193061056610.1007\/s12022-018-9563-2"},{"key":"b10","series-title":"Hum Pathol","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1016\/S0046-8177(97)90005-8","article-title":"The clinicopathological characteristics of gonadotroph cell adenoma: a study of 118 cases","volume":"28","author":"Ho DMT","year":"1997","unstructured":"Ho DMT, Hsu CY, Ting LT, Chiang H: The clinicopathological characteristics of gonadotroph cell adenoma: a study of 118 cases. Hum Pathol 28:905\u2013911, 1997926982610.1016\/S0046-8177(97)90005-8"},{"key":"b11","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1227\/NEU.0b013e318257c1f0","article-title":"Silent corticotroph adenomas: Emory University cohort and comparison with ACTH-negative nonfunctioning pituitary adenomas","volume":"71","author":"Ioachimescu AG","year":"2012","unstructured":"Ioachimescu AG, Eiland L, Chhabra VS, Mastrogianakis GM, Schniederjan MJ, Brat D, : Silent corticotroph adenomas: Emory University cohort and comparison with ACTH-negative nonfunctioning pituitary adenomas. Neurosurgery 71:296\u2013304, 201210.1227\/NEU.0b013e318257c1f022517250"},{"key":"b12","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"1992","DOI":"10.1210\/jc.2011-0251","article-title":"Radiation therapy in the management of pituitary adenomas","volume":"96","author":"Loeffler JS","year":"2011","unstructured":"Loeffler JS, Shih HA: Radiation therapy in the management of pituitary adenomas. J Clin Endocrinol Metab 96:1992\u20132003, 201110.1210\/jc.2011-025121525155"},{"key":"b13","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1007\/s11060-014-1425-2","article-title":"Silent (clinically nonfunctioning) pituitary adenomas","volume":"117","author":"Mayson SE","year":"2014","unstructured":"Mayson SE, Snyder PJ: Silent (clinically nonfunctioning) pituitary adenomas. J Neurooncol 117:429\u2013436, 20142467667510.1007\/s11060-014-1425-2"},{"key":"b14","series-title":"Endocr Pathol","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1007\/s12022-017-9498-z","article-title":"Overview of the 2017 WHO Classification of Pituitary Tumors","volume":"28","author":"Mete O","year":"2017","unstructured":"Mete O, Lopes MB: Overview of the 2017 WHO Classification of Pituitary Tumors. Endocr Pathol 28:228\u2013243, 20172876605710.1007\/s12022-017-9498-z"},{"key":"b15","series-title":"J Endocr Soc","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1210\/js.2018-00121","article-title":"Predictors of postoperative diabetes insipidus following endoscopic resection of pituitary adenomas","volume":"2","author":"Nayak P","year":"2018","unstructured":"Nayak P, Montaser AS, Hu J, Prevedello DM, Kirschner LS, Ghalib L: Predictors of postoperative diabetes insipidus following endoscopic resection of pituitary adenomas. J Endocr Soc 2:1010\u20131019, 201810.1210\/js.2018-0012130140786"},{"key":"b16","series-title":"Endocr Pathol","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s12022-015-9398-z","article-title":"The complementary role of transcription factors in the accurate diagnosis of clinically nonfunctioning pituitary adenomas","volume":"26","author":"Nishioka H","year":"2015","unstructured":"Nishioka H, Inoshita N, Mete O, Asa SL, Hayashi K, Takeshita A, : The complementary role of transcription factors in the accurate diagnosis of clinically nonfunctioning pituitary adenomas. Endocr Pathol 26:349\u2013355, 20152648162810.1007\/s12022-015-9398-z"},{"key":"b17","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/s11102-018-0869-3","article-title":"Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas","volume":"21","author":"Ntali G","year":"2018","unstructured":"Ntali G, Wass JA: Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas. Pituitary 21:111\u2013118, 201810.1007\/s11102-018-0869-329368293"},{"key":"b18","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"1745","DOI":"10.1210\/jc.2011-3163","article-title":"Expression of Ki-67, PTTG1, FGFR4, and SSTR 2, 3, and 5 in nonfunctioning pituitary adenomas: a high throughput TMA, immunohistochemical study","volume":"97","author":"Ram\u00edrez C","year":"2012","unstructured":"Ram\u00edrez C, Cheng S, Vargas G, Asa SL, Ezzat S, Gonz\u00e1lez B, : Expression of Ki-67, PTTG1, FGFR4, and SSTR 2, 3, and 5 in nonfunctioning pituitary adenomas: a high throughput TMA, immunohistochemical study. J Clin Endocrinol Metab 97:1745\u20131751, 20122241971310.1210\/jc.2011-3163"},{"key":"b19","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1227\/01.NEU.0000223437.51435.6E","article-title":"Pathobiology of pituitary adenomas and carcinomas","volume":"59","author":"Scheithauer BW","year":"2006","unstructured":"Scheithauer BW, Gaffey TA, Lloyd RV, Sebo TJ, Kovacs KT, Horvath E, : Pathobiology of pituitary adenomas and carcinomas. Neurosurgery 59:341\u2013353, 20061688317410.1227\/01.NEU.0000223437.51435.6E"},{"key":"b20","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.clineuro.2012.08.009","article-title":"Diabetes insipidus following resection of pituitary tumors","volume":"115","author":"Schreckinger M","year":"2013","unstructured":"Schreckinger M, Szerlip N, Mittal S: Diabetes insipidus following resection of pituitary tumors. Clin Neurol Neurosurg 115:121\u2013126, 201310.1016\/j.clineuro.2012.08.00922921808"},{"key":"b21","series-title":"Eur J Endocrinol","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1530\/EJE-14-0144","article-title":"The incidence rate of pituitary adenomas in western Sweden for the period 2001\u20132011","volume":"171","author":"Tj\u00f6rnstrand A","year":"2014","unstructured":"Tj\u00f6rnstrand A, Gunnarsson K, Evert M, Holmberg E, Ragnarsson O, Ros\u00e9n T, : The incidence rate of pituitary adenomas in western Sweden for the period 2001\u20132011. Eur J Endocrinol 171:519\u2013526, 201410.1530\/EJE-14-014425084775"},{"key":"b22","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1007\/s00701-004-0298-0","article-title":"Expression of cell proliferation markers in pituitary adenomas \u2013 correlation and clinical relevance of MIB-1 and anti-topoisomerase-II\u03b1","volume":"146","author":"Wolfsberger S","year":"2004","unstructured":"Wolfsberger S, Wunderer J, Zachenhofer I, Czech T, B\u00f6cher-Schwarz HG, Hainfellner J, Expression of cell proliferation markers in pituitary adenomas \u2013 correlation and clinical relevance of MIB-1 and anti-topoisomerase-II\u03b1. Acta Neurochir (Wien) 146:831\u2013839, 200410.1007\/s00701-004-0298-0"},{"key":"b23","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s007010050285","article-title":"Expression of P27kip1 and Ki-67 in pituitary adenomas: an investigation of marker of adenoma invasiveness","volume":"141","author":"Zhao D","year":"1999","unstructured":"Zhao D, Tomono Y, Nose T: Expression of P27kip1 and Ki-67 in pituitary adenomas: an investigation of marker of adenoma invasiveness. Acta Neurochir (Wien) 141:187\u2013192, 199910.1007\/s007010050285"},{"key":"b1","series-title":"Histopathology","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1111\/his.13295","article-title":"What\u2019s new in pituitary pathology?","volume":"72","author":"Asa SL","year":"2018","unstructured":"Asa SL, Mete O: What\u2019s new in pituitary pathology? Histopathology 72:133\u2013141, 20182923903310.1111\/his.13295"},{"key":"b2","series-title":"Endocr Pathol","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s12022-014-9347-2","article-title":"Null cell adenomas of the pituitary gland: an institutional review of their clinical imaging and behavioral characteristics","volume":"26","author":"Balogun JA","year":"2015","unstructured":"Balogun JA, Monsalves E, Juraschka K, Parvez K, Kucharczyk W, Mete O, : Null cell adenomas of the pituitary gland: an institutional review of their clinical imaging and behavioral characteristics. Endocr Pathol 26:63\u201370, 201510.1007\/s12022-014-9347-225403448"},{"key":"b3","series-title":"Pituitary","first-page":"267","article-title":"Radically resected pituitary adenomas: prognostic role of Ki 67 labeling index in a monocentric retrospective series and literature review","volume":"17","author":"Chiloiro S","year":"2014","unstructured":"Chiloiro S, Bianchi A, Doglietto F, de Waure C, Giampietro A, Fusco A, : Radically resected pituitary adenomas: prognostic role of Ki 67 labeling index in a monocentric retrospective series and literature review. Pituitary 17:267\u2013276, 2014"},{"key":"b4","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"4769","DOI":"10.1210\/jc.2006-1668","article-title":"High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium","volume":"91","author":"Daly AF","year":"2006","unstructured":"Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A: High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab 91:4769\u20134775, 200610.1210\/jc.2006-166816968795"},{"key":"b5","series-title":"J Clin Endocrinol Metab","first-page":"168","article-title":"Pituitary tumor registry: a novel clinical resource","volume":"85","author":"Drange MR","year":"2000","unstructured":"Drange MR, Fram NR, Herman-Bonert V, Melmed S: Pituitary tumor registry: a novel clinical resource. J Clin Endocrinol Metab 85:168\u2013174, 200010634382"},{"key":"b6","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"2473","DOI":"10.1210\/jc.2018-00688","article-title":"Clinical and pathological aspects of silent pituitary adenomas","volume":"104","author":"Drummond J","year":"2019","unstructured":"Drummond J, Roncaroli F, Grossman AB, Korbonits M: Clinical and pathological aspects of silent pituitary adenomas. J Clin Endocrinol Metab 104:2473\u20132489, 20193002046610.1210\/jc.2018-00688"},{"key":"b7","series-title":"Radiother Oncol","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/j.radonc.2009.09.011","article-title":"Radiotherapy for pituitary adenomas: long-term efficacy and toxicity","volume":"93","author":"Erridge SC","year":"2009","unstructured":"Erridge SC, Conkey DS, Stockton D, Strachan MWJ, Statham PFX, Whittle IR, : Radiotherapy for pituitary adenomas: long-term efficacy and toxicity. Radiother Oncol 93:597\u2013601, 20091990072910.1016\/j.radonc.2009.09.011"},{"key":"b8","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"527","DOI":"10.3171\/2014.5.JNS131819","article-title":"Descriptive epidemiology of pituitary tumors in the United States, 2004\u20132009","volume":"121","author":"Gittleman H","year":"2014","unstructured":"Gittleman H, Ostrom QT, Farah PD, Ondracek A, Chen Y, Wolinsky Y, : Descriptive epidemiology of pituitary tumors in the United States, 2004\u20132009. J Neurosurg 121:527\u2013535, 20142492665010.3171\/2014.5.JNS131819"},{"key":"b9","series-title":"Endocr Pathol","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1007\/s12022-018-9563-2","article-title":"The prognostic roles of the Ki-67 proliferation index, P53 expression, mitotic index, and radiological tumor invasion in pituitary adenomas","volume":"30","author":"Hasanov R","year":"2019","unstructured":"Hasanov R, Aydo\u011fan B\u0130, Kiremit\u00e7i S, Erden E, G\u00fcll\u00fc S: The prognostic roles of the Ki-67 proliferation index, P53 expression, mitotic index, and radiological tumor invasion in pituitary adenomas. Endocr Pathol 30:49\u201355, 20193061056610.1007\/s12022-018-9563-2"},{"key":"b10","series-title":"Hum Pathol","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1016\/S0046-8177(97)90005-8","article-title":"The clinicopathological characteristics of gonadotroph cell adenoma: a study of 118 cases","volume":"28","author":"Ho DMT","year":"1997","unstructured":"Ho DMT, Hsu CY, Ting LT, Chiang H: The clinicopathological characteristics of gonadotroph cell adenoma: a study of 118 cases. Hum Pathol 28:905\u2013911, 1997926982610.1016\/S0046-8177(97)90005-8"},{"key":"b11","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1227\/NEU.0b013e318257c1f0","article-title":"Silent corticotroph adenomas: Emory University cohort and comparison with ACTH-negative nonfunctioning pituitary adenomas","volume":"71","author":"Ioachimescu AG","year":"2012","unstructured":"Ioachimescu AG, Eiland L, Chhabra VS, Mastrogianakis GM, Schniederjan MJ, Brat D, : Silent corticotroph adenomas: Emory University cohort and comparison with ACTH-negative nonfunctioning pituitary adenomas. Neurosurgery 71:296\u2013304, 201210.1227\/NEU.0b013e318257c1f022517250"},{"key":"b12","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"1992","DOI":"10.1210\/jc.2011-0251","article-title":"Radiation therapy in the management of pituitary adenomas","volume":"96","author":"Loeffler JS","year":"2011","unstructured":"Loeffler JS, Shih HA: Radiation therapy in the management of pituitary adenomas. J Clin Endocrinol Metab 96:1992\u20132003, 201110.1210\/jc.2011-025121525155"},{"key":"b13","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1007\/s11060-014-1425-2","article-title":"Silent (clinically nonfunctioning) pituitary adenomas","volume":"117","author":"Mayson SE","year":"2014","unstructured":"Mayson SE, Snyder PJ: Silent (clinically nonfunctioning) pituitary adenomas. J Neurooncol 117:429\u2013436, 20142467667510.1007\/s11060-014-1425-2"},{"key":"b14","series-title":"Endocr Pathol","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1007\/s12022-017-9498-z","article-title":"Overview of the 2017 WHO Classification of Pituitary Tumors","volume":"28","author":"Mete O","year":"2017","unstructured":"Mete O, Lopes MB: Overview of the 2017 WHO Classification of Pituitary Tumors. Endocr Pathol 28:228\u2013243, 20172876605710.1007\/s12022-017-9498-z"},{"key":"b15","series-title":"J Endocr Soc","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1210\/js.2018-00121","article-title":"Predictors of postoperative diabetes insipidus following endoscopic resection of pituitary adenomas","volume":"2","author":"Nayak P","year":"2018","unstructured":"Nayak P, Montaser AS, Hu J, Prevedello DM, Kirschner LS, Ghalib L: Predictors of postoperative diabetes insipidus following endoscopic resection of pituitary adenomas. J Endocr Soc 2:1010\u20131019, 201810.1210\/js.2018-0012130140786"},{"key":"b16","series-title":"Endocr Pathol","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s12022-015-9398-z","article-title":"The complementary role of transcription factors in the accurate diagnosis of clinically nonfunctioning pituitary adenomas","volume":"26","author":"Nishioka H","year":"2015","unstructured":"Nishioka H, Inoshita N, Mete O, Asa SL, Hayashi K, Takeshita A, : The complementary role of transcription factors in the accurate diagnosis of clinically nonfunctioning pituitary adenomas. Endocr Pathol 26:349\u2013355, 20152648162810.1007\/s12022-015-9398-z"},{"key":"b17","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/s11102-018-0869-3","article-title":"Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas","volume":"21","author":"Ntali G","year":"2018","unstructured":"Ntali G, Wass JA: Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas. Pituitary 21:111\u2013118, 201810.1007\/s11102-018-0869-329368293"},{"key":"b18","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"1745","DOI":"10.1210\/jc.2011-3163","article-title":"Expression of Ki-67, PTTG1, FGFR4, and SSTR 2, 3, and 5 in nonfunctioning pituitary adenomas: a high throughput TMA, immunohistochemical study","volume":"97","author":"Ram\u00edrez C","year":"2012","unstructured":"Ram\u00edrez C, Cheng S, Vargas G, Asa SL, Ezzat S, Gonz\u00e1lez B, : Expression of Ki-67, PTTG1, FGFR4, and SSTR 2, 3, and 5 in nonfunctioning pituitary adenomas: a high throughput TMA, immunohistochemical study. J Clin Endocrinol Metab 97:1745\u20131751, 20122241971310.1210\/jc.2011-3163"},{"key":"b19","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1227\/01.NEU.0000223437.51435.6E","article-title":"Pathobiology of pituitary adenomas and carcinomas","volume":"59","author":"Scheithauer BW","year":"2006","unstructured":"Scheithauer BW, Gaffey TA, Lloyd RV, Sebo TJ, Kovacs KT, Horvath E, : Pathobiology of pituitary adenomas and carcinomas. Neurosurgery 59:341\u2013353, 20061688317410.1227\/01.NEU.0000223437.51435.6E"},{"key":"b20","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.clineuro.2012.08.009","article-title":"Diabetes insipidus following resection of pituitary tumors","volume":"115","author":"Schreckinger M","year":"2013","unstructured":"Schreckinger M, Szerlip N, Mittal S: Diabetes insipidus following resection of pituitary tumors. Clin Neurol Neurosurg 115:121\u2013126, 201310.1016\/j.clineuro.2012.08.00922921808"},{"key":"b21","series-title":"Eur J Endocrinol","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1530\/EJE-14-0144","article-title":"The incidence rate of pituitary adenomas in western Sweden for the period 2001\u20132011","volume":"171","author":"Tj\u00f6rnstrand A","year":"2014","unstructured":"Tj\u00f6rnstrand A, Gunnarsson K, Evert M, Holmberg E, Ragnarsson O, Ros\u00e9n T, : The incidence rate of pituitary adenomas in western Sweden for the period 2001\u20132011. Eur J Endocrinol 171:519\u2013526, 201410.1530\/EJE-14-014425084775"},{"key":"b22","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1007\/s00701-004-0298-0","article-title":"Expression of cell proliferation markers in pituitary adenomas \u2013 correlation and clinical relevance of MIB-1 and anti-topoisomerase-II\u03b1","volume":"146","author":"Wolfsberger S","year":"2004","unstructured":"Wolfsberger S, Wunderer J, Zachenhofer I, Czech T, B\u00f6cher-Schwarz HG, Hainfellner J, Expression of cell proliferation markers in pituitary adenomas \u2013 correlation and clinical relevance of MIB-1 and anti-topoisomerase-II\u03b1. Acta Neurochir (Wien) 146:831\u2013839, 200410.1007\/s00701-004-0298-0"},{"key":"b23","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s007010050285","article-title":"Expression of P27kip1 and Ki-67 in pituitary adenomas: an investigation of marker of adenoma invasiveness","volume":"141","author":"Zhao D","year":"1999","unstructured":"Zhao D, Tomono Y, Nose T: Expression of P27kip1 and Ki-67 in pituitary adenomas: an investigation of marker of adenoma invasiveness. Acta Neurochir (Wien) 141:187\u2013192, 199910.1007\/s007010050285"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/48\/6\/article-pE13.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/48\/6\/article-pE13.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/48\/6\/article-pE13.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T08:38:59Z","timestamp":1778315939000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/48\/6\/article-pE13.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6]]},"references-count":46,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2020.3.focus20114","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6]]}}}