Clinical characteristics and prognostic outcomes of silent corticotroph versus gonadotroph adenomas: A 603-case single-center cohort study.

Silent corticotroph adenomas (SCAs) and silent gonadotroph adenomas (SGAs) are subtypes of non-functioning pituitary adenomas (NFPAs).However, studies comparing SCAs and SGAs are scarce, and their differences in clinical features, behavior, and prognosis are not well understood. This retrospective cohort study included 603 NFPA patients (188 SCAs, 415 SGAs) who underwent surgery at Beijing Tiantan Hospital between 2020 and 2025. Data were collected to compare features between groups, and Cox models identified predictors of postoperative radiological progression/recurrence. A nomogram was developed and evaluated using ROC, calibration, and decision curve analysis. SCAs were more common in younger women, while SGAs predominated in men. SCAs had larger tumor size (29.7 ± 10.8 mm vs. 27.9 ± 9.3 mm, P = 0.043), more cavernous sinus invasion (69% vs. 41%, P < 0.001), and more intratumoral hemorrhage (10.1% vs. 2.9%, P < 0.001) compared to SGAs, but a lower gross total resection rate (GTR) (86.7% vs. 92.5%, P = 0.022). Postoperative venous thromboembolism (VTE) was more frequent in SCAs (16% vs. 9.6%, P = 0.025). Multivariate Cox analysis identified distinct recurrence predictors: for SCAs, younger age, recurrent tumors, subtotal resection, and firm consistency increased recurrence risk; for SGAs, larger tumor size, subtotal resection, firm consistency, and Ki-67 ≥ 3% were predictive. The nomograms showed good apparent discrimination, and bootstrap internal validation demonstrated that both models retained good discriminative ability after correction for optimism. The AUCs for 2- and 4-year radiological progression/recurrence prediction were 0.934 and 0.914 for SCAs, and 0.898 and 0.882 for SGAs, respectively. Calibration and decision curve analyses suggested acceptable model performance within this cohort; however, external validation is required before clinical application. SCAs and SGAs differ in demographics, tumor behavior, and postoperative outcomes. SCAs are more invasive with lower GTR and higher VTE risk, while SGAs are firmer and more likely to cause pituitary dysfunction. The recurrence model supports individualized follow-up and early identification of high-risk patients.