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4 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
A corticotroph tumour is a pituitary tumour of the cells that make ACTH. When it secretes it floods the body with cortisol, causing Cushing disease (weight gain, diabetes, high blood pressure, thin skin); the silent form is found as a large non-functioning mass. Surgery through the nose is the main treatment; cortisol-lowering drugs, repeat surgery or radiotherapy follow for those not cured.
The 2022 WHO classification places the corticotroph tumour in the TPIT lineage with densely granulated, sparsely granulated and Crooke cell subtypes, functioning (Cushing disease) or silent (Asa 2022). Silent corticotroph tumours were graded as high-risk adenomas in the 2017 classification; a meta-analysis of 14 studies with 297 patients found a recurrence rate of 5.96 per 100 person-years and recurrence in 31 percent at five or more years, without proof of a higher risk than other non-functioning adenomas (JCEM 2018). In 100 silent corticotroph against 841 other non-functioning adenomas at one institution, the silent corticotroph group presented more often with cranial neuropathy (13 against 5.7 percent) and the series defined recurrence patterns and treatment strategies (J Neurosurg 2021).
How it differs from its parent: the functioning tumour is usually a microadenoma diagnosed by the endocrine syndrome and cured by selective surgery in most, whereas the silent tumour is a macroadenoma diagnosed by mass effects; both recur more than other pituitary tumours and the Crooke cell subtype is aggressive.
| Setting | Approach | Guideline |
|---|---|---|
| Cushing disease, first line | Transsphenoidal selective adenomectomy. | not mapped |
| Persistent or recurrent | Repeat surgery, radiotherapy, osilodrostat or other cortisol-directed drugs, pasireotide or cabergoline, or bilateral adrenalectomy; temozolomide for aggressive tumours. | not mapped |