Endocrine Pathology

, 2:111 | Cite as

Pituitary corticotroph adenoma with crooke’s hyalinization

  • Sebastiano Franscella
  • Charles-Abram Favrod-Coune
  • Gianpaolo Pizzolato
  • Sylvia L. Asa
  • Rolf Gaillard
  • Jean Berney
  • Jacques Philippe
Case Report


The diagnosis of pituitary corticotroph adenoma relies on the demonstration of a loss of the normal feedback control of adrenocorticotropic hormone (ACTH) biosynthesis by cortisol. The marked variability in the degree of ACTH suppression by glucocorticoids in these tumors, however, greatly enhances the difficulty in distinguishing Cushing’s disease from other syndromes of glucocorticoid excess. To illustrate this variability, we describe the clinical, biochemical, and morphological characteristics of a pituitary corticotroph adenoma in a 63-year-old woman, who presented with symptoms of a sellar mass but did not initially have florid Cushing’s disease. Light and electron microscopy of the pituitary tumor showed a corticotroph adenoma with Crooke’s hyalinization of the tumor cells, characterized by the accumulation of keratin immunoreactive microfilaments similar to those observed in normal corticotrophs in the presence of excess glucocorticoids. This case illustrates an unusual clinical presentation that may be associated with pituitary corticotroph adenoma showing Crooke’s hyalinization.


Adenoma Pituitary Adenoma Endocrine Pathology Volume Corticotroph Adenoma Excess Glucocorticoid 


  1. 1.
    Cushing HW. The pituitary body and its disorders: clinical states produced by disorders of the hypophysis cerebri. Philadelphia: Lippincott, 1912.Google Scholar
  2. 2.
    De Cicco FA, Dekker A, Yunis EJ. Fine structure of the Crooke’s hyaline change in the human pituitary gland. Arch Pathol 94:65–70, 1972.Google Scholar
  3. 3.
    Felix IA, Horvath E, Kovacs K. Massive Crooke’s hyalinisation in corticotroph cell adenomas of the human pituitary. Acta Neurochir (Wien) 58:235–243, 1981.CrossRefGoogle Scholar
  4. 4.
    Horvath E, Kovacs K, Josse R. Pituitary corticotroph cell adenoma with marked abundance of microfilaments. Ultrastruct Pathol 5:249–255, 1983.PubMedCrossRefGoogle Scholar
  5. 5.
    Horvath E, Kovacs K, Killinger DW, Smith HS, Platts ME, Singer W. Silent corticotroph adenomas of the human pituitary gland. Am J Pathol 98:617–624, 1980.PubMedGoogle Scholar
  6. 6.
    Horvath SE, Asa SL, Kovacs K, Adams LA, Singer W, Smyth HS. Human pituitary corticotroph adenomas in vitro: morphologic and functional responses to corticotropinreleasing hormone and cortisol. Neuroendocrinology 51:241–248, 1990.PubMedCrossRefGoogle Scholar
  7. 7.
    Kovacs K, Horvath E. Amphophil adenoma of the human pituitary gland with masses of cytoplasmic microfilaments. Endokrinologie 63:402–408, 1974.PubMedGoogle Scholar
  8. 8.
    Kovacs K, Horvath E. Tumors of the pituitary gland. In: Atlas of tumor pathology, fascicle 21, second series. Hartman WH, ed. Washington, DC: Armed Forces Institute of Pathology, 1986.Google Scholar
  9. 9.
    Krieger DT. Physiopathology of Cushing’s disease. Endocr Rev 4:22–42, 1983.PubMedGoogle Scholar
  10. 10.
    Landis CA, Masters SB, Spada A, Pace AM, Bourne HR, Vallar L. GTPase inhibitory mutations activate the alpha chain of Gs and stimulate adenylyl cyclase in human pituitary tumors. Nature 340:692–696, 1989.PubMedCrossRefGoogle Scholar
  11. 11.
    McNicol AM. Patterns of corticotropic cells in the adult human pituitary in Cushing’s disease. Diagn Histopathol 4:335–341, 1981.PubMedGoogle Scholar
  12. 12.
    Neuman PE, Horoupian DS, Goldman JE, Hess MA. Cytoplasmic filaments of Crooke’s hyaline changes belong to the cytokeratin class. Am J Pathol 116:214–222, 1984.Google Scholar
  13. 13.
    Ostlund RE. Contractile proteins and pancreatic secretion. Diabetes 26:245–254, 1977.PubMedCrossRefGoogle Scholar
  14. 14.
    Plotz CM, Knowlton AI, Ragan C. The natural history of dishing’s syndrome. Am J Med 13:597–614, 1952.PubMedCrossRefGoogle Scholar
  15. 15.
    Robert F, Pelletier G, Hardy J. Pituitary adneoma in Cushing’s disease: a histological, ultrastructural and immunocytochemical study. Arch Pathol Lab Med 102:448–455, 1978.PubMedGoogle Scholar
  16. 16.
    Trouillas J, Girod C, Sassolas G, Vitte PA, Claustrat B, Perrin G, L’Heritier M, Fischer C, Dubois MP. A human beta-endorphin pituitary adenoma. J Clin Endocrinol Metab 58:242–249, 1984.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 1991

Authors and Affiliations

  • Sebastiano Franscella
    • 1
  • Charles-Abram Favrod-Coune
    • 1
  • Gianpaolo Pizzolato
    • 3
  • Sylvia L. Asa
    • 5
  • Rolf Gaillard
    • 1
  • Jean Berney
    • 2
  • Jacques Philippe
    • 1
    • 4
  1. 1.Departments of Medicine (Division of Endocrinology)Hopital Cantonal Universitaire de Geneve and Centre Medical UniversitaireSwitzerland
  2. 2.Departments of Surgery (Division of Oto-Neuro-Surgery)Hopital Cantonal Universitaire de Geneve and Centre Medical UniversitaireGeneva 4Switzerland
  3. 3.Departments of PathologyHopital Cantonal Universitaire de Geneve and Centre Medical UniversitaireGeneva 4Switzerland
  4. 4.Departments of MicrobiologyHopital Cantonal Universitaire de Geneve and Centre Medical UniversitaireGeneva 4Switzerland
  5. 5.Department of PathologySt. Michael’s HospitalTorontoCanada

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