Case Report	Exp Clin Endocrinol Diabetes 2007; 115: 610-615 DOI: 10.1055/s-2007-984437
© J. A. Barth Verlag in Georg Thieme Verlag KG · Stuttgart · New York
Atypical Type II Silent Corticotrophic Adenoma Developing into Cushing's Disease upon Second Recurrence
T. Psaras1, J. Honegger1, R. Buslei2, W. Saeger3, D. Klein4, D. Capper5, R. Meyermann5, M. Mittelbronn5
1Department of Neurosurgery, University of Tuebingen, Germany 2Department of Neuropathology, University of Erlangen, Germany 3Institute of Pathology, Marien Hospital, Hamburg, Germany 4Internal Medicine, Weil der Stadt, Germany 5Institute of Brain Research, University of Tuebingen, Germany

Abstract

Herein, we report the case of a 73-year old male patient who presented with two recurrences of a pituitary adenoma within a period of 15 years. The first tumor resection 15 years ago revealed a non-functioning pituitary macroadenoma. 11 years later, the first recurrence of the tumor was reoperated. Throughout the early course of the disease, he suffered from secondary adrenal insufficiency and required replacement therapy with hydrocortisone. Currently, he presented with the second recurrence and clinical examination revealed signs of Cushing's disease. This was clearly confirmed by endocrinological evaluation. A retrospective analysis of all histological and immunohistochemical slides rendered an adenoma exhibiting chromophobia, ACTH-positivity and features of atypia such as elevated p53 and Ki67 expression as well as nuclear polymorphism. According to the revised WHO classification it was classified as atypical type II silent corticotroph adenoma at the time of the first and second surgery. The specimen removed during the recent surgery displayed the same histological features and was classified as corticotroph adenoma. The combination of an atypical type II adenoma and the switch in the hormone status to an endocrinologically active adenoma makes this case exceedingly rare.

Key words

pituitary gland - ACTH - recurrence - silent corticotrophic adenoma