Endocrine Abstracts

Introduction: Silent corticotropic adenoma (SCA) is defined by the absence of clinical manifestations of Cushing’s disease despite the presence of ACTH and/or its precursors in tumor cells. It is a rare entity that represents 10% of pituitary tumors. It is known for its increasing expansion. Its clinical presentation is dominated by symptoms of tumor mass effect. We report the case of a silent corticotropic adenoma revealed by headache.

Case report: 67-year-old patient, not known to be diabetic or having hypertension; referred in our departement for post-operative monitoring of an operated pituitary macroadenoma. At clinical assessement, the patient complains of retro-orbital headaches with a decrease in visual acuity, without any signs of insufficiency or pituitary hypesecretion. A pituitary magnetic resonance imaging (MRI) is performed, showing a sellar and supra-sellar mass of 35 × 29 × 24 mm in diameter. The surgical indication was retained. The patient was operated on 3 times. The histological study confirms the diagnostic hypothesis of a corticotropic pituitary adenoma. Postoperatively, the patient developed gonadotropic and thyreotropic insufficiency. A substitution with Levothyroxine at 25 µg per day is instituted. The other ante- pituitary functions are normal with a prolactin level and a cortisoluria of 24 hours in the norms; while MRI monitoring showed the persistence of the sellar and suprasellar tumor process measuring 40 × 37 × 22 mm enhanced by contrast, with compression of the optic chiasm and the pituitary stalk and invasion of the right cavernous sinus. Currently, she is a candidate for surgery once again.

Discussion and conclusion

In summary, SCA is a distinct and aggressive subtype of pituitary adenomas. Preoperatively, they can be in the form of non-functioning pituitary adenomas and must be closely monitored postoperatively for the development of hypopituitarism, frequent recurrences, and more rarely for possible transformation into Cusching disease. Multimodal therapy may be necessary to adequately manage patients in whom the disease recurs, and larger clinical trials will hopefully demonstrate more effective drugs.