# Corticotroph pituitary neuroendocrine tumour (Cushing disease and silent corticotroph tumour)

Source: https://onco.cc/cancers/corticotroph-pitnet/  
OnCo record `corticotroph-pitnet` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

How common: no separate incidence figure in the sources read.

Treatment: transsphenoidal selective adenomectomy first; for persistent or recurrent Cushing disease, repeat surgery, radiotherapy (including radiosurgery), and cortisol-directed drugs (osilodrostat, ketoconazole, metyrapone), pasireotide or cabergoline directed at the tumour, or bilateral adrenalectomy; silent tumours by surgery and radiotherapy for regrowth, with temozolomide for aggressive tumours, as on the parent page.

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: Corticotroph tumour; Corticotroph tumour (Cushing disease, silent corticotroph); ACTH-secreting pituitary adenoma; Cushing disease; Silent corticotroph adenoma; Crooke cell tumour
- Tags: subtype-page; wave4; rare
- Group: endocrine
- Burden: The tumour behind Cushing disease and about a tenth of non-functioning pituitary tumours in its silent form; one centre operated on 100 silent corticotroph and 841 other non-functioning adenomas over 2000 to 2019 (J Neurosurg 2021). GLOBOCAN does not count pituitary tumours.
- Subtypes: Densely granulated corticotroph tumour (typical Cushing disease microadenoma); Sparsely granulated corticotroph tumour; Crooke cell tumour (aggressive); Silent corticotroph tumour (ACTH-immunopositive, non-functioning macroadenoma; 31 percent recur)
- Biomarkers: Late-night salivary cortisol, urinary free cortisol, dexamethasone suppression, plasma ACTH; TPIT lineage and ACTH immunostaining; Crooke hyaline change; Inferior petrosal sinus sampling when MRI is negative; Ki-67 and USP8 mutation (functioning microadenomas)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/corticotroph-pitnet/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/corticotroph-pitnet/#overview
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/corticotroph-pitnet/#what-it-is [4 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/corticotroph-pitnet/#finding-it [4 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/corticotroph-pitnet/#treating-it [2 settings, 1 decision with options]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/corticotroph-pitnet/#evidence
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/corticotroph-pitnet/#science [2 targets]
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/corticotroph-pitnet/where-you-are/
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/corticotroph-pitnet/#living-with-it [9 questions, 2 red cards]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/corticotroph-pitnet/coming/ [5 medicines]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/corticotroph-pitnet/data/ [13 connected records]

## Standard of care

- Cushing disease, first line: Transsphenoidal selective adenomectomy. ([Pituitary tumours (pituitary neuroendocrine tumours) and pituitary carcinoma](https://onco.cc/cancers/pituitary-tumours/))
- Persistent or recurrent: Repeat surgery, radiotherapy, osilodrostat or other cortisol-directed drugs, pasireotide or cabergoline, or bilateral adrenalectomy; temozolomide for aggressive tumours. ([Osilodrostat](https://onco.cc/drugs/osilodrostat/), [Pasireotide](https://onco.cc/drugs/pasireotide/), [Cabergoline](https://onco.cc/drugs/cabergoline/), [Stereotactic radiosurgery (Gamma Knife, CyberKnife, linac SRS)](https://onco.cc/technologies/radiosurgery-srs/), [Temozolomide](https://onco.cc/drugs/temozolomide/), [Mifepristone](https://onco.cc/drugs/mifepristone/))

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Cushing%27s_disease
- NCI PDQ: pituitary tumours treatment: https://www.cancer.gov/types/pituitary/treatment
- Asa 2022, Endocrine Pathology: overview of the 2022 WHO classification of pituitary tumours: https://doi.org/10.1007/s12022-022-09703-7
- JCEM 2018: recurrence in silent corticotroph adenomas after primary treatment, meta-analysis of 297 patients: https://doi.org/10.1210/jc.2018-01956
- J Neurosurg 2021: silent corticotroph adenomas, 100 patients against 841 other non-functioning adenomas: https://doi.org/10.3171/2020.10.jns203236

## Connected records

- cancers: [Adrenocortical carcinoma](https://onco.cc/cancers/adrenocortical/), [Gonadotroph pituitary neuroendocrine tumour (non-functioning adenoma)](https://onco.cc/cancers/gonadotroph-pitnet/), [Lactotroph pituitary neuroendocrine tumour (prolactinoma)](https://onco.cc/cancers/lactotroph-pitnet/), [Pituitary tumours (pituitary neuroendocrine tumours) and pituitary carcinoma](https://onco.cc/cancers/pituitary-tumours/), [Somatotroph pituitary neuroendocrine tumour (acromegaly)](https://onco.cc/cancers/somatotroph-pitnet/)
- technologies: [Stereotactic radiosurgery (Gamma Knife, CyberKnife, linac SRS)](https://onco.cc/technologies/radiosurgery-srs/)
- drugs: [Cabergoline](https://onco.cc/drugs/cabergoline/), [Mifepristone](https://onco.cc/drugs/mifepristone/), [Osilodrostat](https://onco.cc/drugs/osilodrostat/), [Pasireotide](https://onco.cc/drugs/pasireotide/), [Temozolomide](https://onco.cc/drugs/temozolomide/)

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JSON: https://onco.cc/api/v1/entities/corticotroph-pitnet.json