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Exp Clin Endocrinol Diabetes 2007; 115(9): 610-615
DOI: 10.1055/s-2007-984437
Case Report

© 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. Psaras 1 , J. Honegger 1 , R. Buslei 2 , W. Saeger 3 , D. Klein 4 , D. Capper 5 , R. Meyermann 5 , M. Mittelbronn 5
  • 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
Further Information

Publication History

received 06. 10. 2006 first decision 11. 04. 2007

accepted 14. 06. 2007

Publication Date:
18 October 2007 (online)

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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

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Correspondence

Dr. Michel Mittelbronn

Institute of Neuropathology

University of Zürich

Schmelzbergestrasse 12

8091 Zürich

Phone: +41/44/255 21 51

Fax: +41/44/255 44 02

Email: michael.mittelbronn@usz.ch

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