Crooke Cell Adenoma Confers Poorer Endocrinologic Outcomes Compared with Corticotroph Adenoma: Results of a Multicenter, International Analysis

Background: Crooke cell adenomas (CCA) are a rare, aggressive subset of adrenocorticotrophin secreting pituitary corticotroph adenomas (sCTA) found in 5 to 10% of patients with Cushing’s disease. Multiple studies support worse outcomes in CCA but are limited by small sample size and single-institution databases. We compared outcomes in CCA and sCTA using a multicenter, international retrospective database of high-volume skull base centers.

Methods: Patients surgically treated for pituitary adenoma from January 2017 through December 2020 were included.

Results: A total of 2,826 patients from 12 international centers were compared (n = 20 CCA and n = 480 sCTA). No difference in baseline demographics, tumor characteristics or postoperative complications was seen. Microsurgical approaches (60% CCA vs. 62.3% sCTA) were most common. Gross total resection (GTR) was higher in CCA patients (100 vs. 83%, p = 0.05). Among patients who had GTR according to intraoperative findings, fewer CCA patients had postoperative hormone normalization of pituitary function (50 vs. 77.8%, p < 0.01) and remission of hypersecretion by 3 to 6 months (75 vs. 84.3%, p < 0.01). This was present despite CCA having better local control rates (100 vs. 96%, p < 0.01) and fewer patients with remnant on MRI (0 vs. 7.2%, p < 0.01). A systematic literature review of 35 studies reporting on various treatment strategies reiterated the high rate of residual tumor, persistent hypercortisolism, and tumor-related mortality in CCA patients.

Conclusion: This modern, multicenter series of patients with CCA reflects their poor prognosis and reduced postsurgical hormonal normalization. Further work is necessary to better understand the pathophysiology of CCA to devise more targeted treatment approaches ([Figs. 1], [2]).

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024