Dealing with pituitary invaders: a corticotroph macroadenoma case

Kassi Nada Ait; Nouhaila Essafir; Sara Hairchi; Habbadi Zineb; Fatima Toulali; Ghizlane Sabbar; Kaoutar Rifai; Hinde Iraqi; Hassan Gharbi Mohamed El

doi:10.1530/endoabs.110.EP1138

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Endocrine Abstracts (2025) 110 EP1138 | DOI: 10.1530/endoabs.110.EP1138

ECEESPE2025 ePoster Presentations Pituitary, Neuroendocrinology and Puberty (220 abstracts)

Dealing with pituitary invaders: a corticotroph macroadenoma case

Nada Ait Kassi ¹ , Nouhaila Essafir ¹ , Sara Hairchi ¹ , Habbadi Zineb ² , Fatima Toulali ¹ , Ghizlane Sabbar ¹ , Kaoutar Rifai ¹ , Hinde Iraqi ¹ & Mohamed El Hassan Gharbi ¹

Author affiliations

¹Ibn Sina Hospital Mohamed V University, Rabat, Morocco; ²Ibn Sina Hospital Mohamed V University, Endocrinology, Rabat, Morocco

JOINT50

Introduction: Corticotroph pituitary tumors, particularly invasive macroadenomas, are rare and therapeutically challenging due to their compressive effects and systemic complications. They represent a significant cause of endogenous hypercortisolism in Cushing’s syndrome. This case discusses a complex presentation of an invasive corticotroph macroadenoma in a middle-aged woman, underlining the value of tailored multidisciplinary management to achieve biochemical and clinical control.

Case Presentation: A 46-year-old woman with a history of hypertension and type 2 diabetes was diagnosed with an invasive corticotroph macroadenoma, confirmed by histopathology after transsphenoidal surgery. Imaging revealed a sellar and suprasellar mass with bone erosion and optic chiasm compression. Post-operative complications included hypogonadism and hypothyroidism, requiring hormone replacement therapy. Medical management included ketoconazole, cabergoline, and the planned introduction of Pasireotide to address tumor control and residual hypercortisolism.

Discussion: This case highlights the aggressive nature of corticotroph macroadenomas, characterized by local invasion and systemic effects such as Cushingoid features. Surgical resection remains the first-line treatment; however, complete remission is not always achievable, necessitating adjunctive therapies. Novel pharmacological approaches expand therapeutic options, such as somatostatin analogs and ACTH secretion inhibitors. Furthermore, long-term monitoring is critical due to the potential for recurrence or progression, especially in invasive forms.

Conclusion: Invasive corticotroph macroadenomas require an integrative approach, combining surgery, medical treatment, and close follow-up. Advanced therapies, like Pasireotide, offer promising outcomes in managing persistent disease. This case underscores the importance of individualized care in achieving optimal results for complex pituitary tumors.