Crooke cell corticotrop adenoma: case series

Koroğlu Ekin Yiğit; Cağlar Keskin; Servet Gureşci; Denizhan Divanlıoğlu; Cevdet Aydın; Oya Topaloğlu; Reyhan Ersoy; Bekir Cakır

doi:10.1530/endoabs.99.EP1201

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Endocrine Abstracts (2024) 99 EP1201 | DOI: 10.1530/endoabs.99.EP1201

ECE2024 Eposter Presentations Pituitary and Neuroendocrinology (214 abstracts)

Crooke cell corticotrop adenoma: case series

Ekin Yiğit Köroğlu ¹ , Çağlar Keskin ¹ , Servet Güreşçi ² , Denizhan Divanlıoğlu ³ , Cevdet Aydın ⁴ , Oya Topaloğlu ⁴ , Reyhan Ersoy ⁴ & Bekir Çakır ⁴

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¹Ankara Bilkent City Hospital, Endocrinology and Metabolism, Ankara; ²Ankara Bilkent City Hospital, Pathology, Ankara; ³Ankara Bilkent City Hospital, Neurosurgery, Ankara; ⁴Ankara Yıldırım Beyazıt University Faculty Of Medicine, Endocrinology and Metabolism, Ankara

Crooke cell corticotroph adenomas are a rare subtype of corticotroph adenomas. It can be detected in less than 1% of all pituitary adenomas. They are usually noticed as invasive macroadenomas on preoperative imaging. They are expected to have a more aggressive course and more frequent recurrences during their clinical course. We present a case series of 11 patients who were followed up with Cushing’s Disease in our clinic and were diagnosed with Crooke cell adenoma after surgery. Nine patients were female(81.8%), and 2(18.2%) were male. The average age of the patients was 41.0(19.0-71.0) years. There were macroadenomas in 6 patients(54.5%) and microadenomas in 5 patients(45.5%). The average largest tumor diameter was 14.00 (4.50-35.00) mm. Pituitary adenoma invaded surrounding tissues in 3 patients(27.3%). Optic chiasm compression was observed in 2 patients(18.2%). Preoperative hypopituitarism was present in 6 patients(54.5%). In this group of patients, macroadenoma was detected in 5 patients, and microadenoma was detected in 1. The patients’ preoperative laboratory parameters and clinical findings are given in Table 1 and Table 2, respectively. A 1-milligram dexamethasone suppression test was performed in all patients in the preoperative period, and it was found to be high in all patients. 24-hour urinary cortisol was measured in 8 patients and was high in 5. In the postoperative period, two patients could not be evaluated for remission because they continued their follow-up in another center. Biochemical remission was achieved in 4 of the other nine patients(44.4%), and biochemical remission was not achieved in 5(55.6%). Postoperative follow-up periods of patients in biochemical remission have been 33, 39, 56, and 62 months; no recurrence was observed in any patient during this period.

Table 1. Laboratory parameters of patients with Crooke cell corticotroph adenoma
Test	n	Minimum	Maximum	Mean
ACTH(<46 pg/ml)	11	13,50	443,00	108,8455
Cortisol(5.2-22.4 µg/dl)	11	11,10	60,00	31,0273
1 mg dexamethasone suppression test(<1.8 µg/dl)	9	3,90	43,56	21,1956
24-hour urinary cortisol(3.5-45 µg/day)	8	24,66	2279,63	547,9125
Midnight salivary cortisol(<0.69 µg/dl)	4	,64	2,28	1,6100

Table 2. Clinical findings of patients with Crooke cell corticotroph adenoma
Clinical finding	Present	Absent
Central Obesity	9(81.8%)	2(18.2%)
Proximal myopathy	3(27.3%)	8(72.7%)
Moon face	4(36.4%)	7(63.6%)
Abdominal purple striae	3(27.3%)	8(72.7%)
Buffalo hump	6(54.5%)	5(45.5%)
Hirsutism	5(62.5%)	3(27.3%)
type 2 Diabetes Mellitus	5(45.5%)	6(54.5%)
Hypertension	5(45.5%)	6(54.5%)
Hyperlipidemia	6(54.5%)	5(45.5%)
Osteoporosis	1(9.1%)	10(90.9%)
History of thrombosis	1(9.1%)	10(90.9%)
Hypokalemia	3(27.3%)	8(72.7%)