Year: 2026
Type: conference-abstract
Abstract: Introduction Crooke cell adenomas (CCA) are a rare subtype of corticotroph pituitary adenomas. CCA are usually invasive macroadenomas and can present with Cushing's disease or can be clinically asymptomatic. Case Report A 54-years-old male without relevant past medical history was referred to our endocrinology outpatient clinic after a pituitary macroadenoma was detected on CT performed due to complaints of sinusitis. CT revealed a sellar mass with supra- and infra-sellar extension, marked enlargement of sella turcica, and bone erosion, consistent with macroadenoma. Patient denied headaches or visual changes but reported periocular oedema and tearing for four months, easy bruising and decreased libido. He denied erectile disfunction or weight change. Physical examination showed mild facial plethora, periocular oedema and conjunctival hyperaemia, ecchymosis of the upper limbs, and normal BMI (24.9 kg/m2). Visual fields evaluation by confrontation were normal. Blood work showed glycemia 92 mg/dL, Na+ 144 mmol/L (136-145), K+ 5.3 mmol/L (3.5-5.5), cortisol 26.3 µg/dL (3.7-19.4), ACTH 161 pg/mL (<46), IGF-1 164 ng/mL (55-248), TSH 0.6 uUI/mL (0.350-4.940), fT4 1.27 ng/dL (0.8-1.76), total testosterone 2.4 ng/mL (2.54-8.53), LH 1.63 mUI/mL (0.57-12.07), FSH 4.6 mUI/mL (0.95-11.95), Prolactin 10.6 ng/mL (3.46-19.40). Pituitary MRI confirmed a well-defined macroadenoma with infra-, supra- and latero-sellar extension (predominantly to the left). There was remodelling of the sellar floor, involvement of sphenoidal sinus, posterior fossa and the prepontine cistern, and compression of the optic chiasma, anterior diencephalon and third ventricle. The patient was referred for evaluation in neurosurgery department, however, three days later he developed new-onset diplopia and headache. Ophthalmologic evaluation in the emergency department revealed left abducens nerve paresis and CT showed stability of the tumour. Given the rapid clinical evolution, salivary and 24 h-urinary cortisol were not performed. One week later transsphenoidal surgery was performed and histological diagnosis was Crooke cell adenoma, positive for PIT 1, Chromogranin A, cytokeratin CAM 5.2, and weakly positive for ACTH with Ki-67 <3%. Conclusion This atypical presentation of CCA with periocular oedema and conjunctival hyperaemia, likely resulted from compression of venous structures, highlighting the invasive nature of these adenomas. Although these tumours may retain some corticotroph function, reflected by weak ACTH and chromogranin A positivity, their clinical manifestations are often dominated by mass effect rather than hormone excess.
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,292
OpenAlex ID: W7213337293