Abstract
Background and Objectives
Crooke cell adenomas (CCA) are a rare, aggressive subset of adrenocorticotrophin secreting pituitary corticotroph adenomas (sCTA) found in 5–10% 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
2826 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 that 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 3-6 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 post-surgical hormonal normalization. Further work is necessary to better understand the pathophysiology of CCA to devise more targeted treatment approaches.
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Previous presentations: none
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Previous publications: none
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Disclosures
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No relevant disclosures to report
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CREDIT statement
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Matthew Finlay: conceptualization, writing – review and editing
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Richard Drexler: conceptualization, writing – review and editing
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All: data curation, writing – review and editing
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Michael Karsy: conceptualization, data curation, methodology, writing – original draft, writing – review and editing, supervision
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Funding and Disclosures: none
From https://www.sciencedirect.com/science/article/abs/pii/S187887502301344X
Filed under: Cushing's, pituitary | Tagged: Crooke cell adenomas, Cushing's, pituitary |
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