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

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%)

Volume 99

26th European Congress of Endocrinology

Stockholm, Sweden
11 May 2024 - 14 May 2024

European Society of Endocrinology 

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