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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.
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.
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.
Gliomas infiltrate along white matter and can cross the corpus callosum, medulloblastoma sits in the cerebellum, and CNS lymphoma favours deep periventricular tissue; none spread through lymph nodes.
No conventional lymphatics: gliomas spread along white matter tracts and, rarely, through cerebrospinal fluid; medulloblastoma can seed the spine.
Same organ: Lactotroph pituitary neuroendocrine tumour (prolactinoma), Somatotroph pituitary neuroendocrine tumour (acromegaly), Gonadotroph pituitary neuroendocrine tumour (non-functioning adenoma), Thyrotroph pituitary neuroendocrine tumour (TSH-secreting), Pineocytoma and pineal parenchymal tumour of intermediate differentiation, Pineoblastoma, Papillary tumour of the pineal region, Choroid plexus carcinoma, Glioma & glioblastoma, Primary CNS lymphoma, Medulloblastoma, Paediatric low-grade glioma, Diffuse midline glioma, H3 K27-altered (including DIPG), Atypical teratoid/rhabdoid tumour (ATRT), Ependymoma, Craniopharyngioma, Pituitary tumours (pituitary neuroendocrine tumours) and pituitary carcinoma, Brain and spinal cord tumours (all types), Astrocytoma, IDH-mutant (grades 2 to 4), Oligodendroglioma, IDH-mutant and 1p/19q-codeleted, Paediatric high-grade glioma (excluding diffuse midline glioma), Meningioma, Brain metastases (secondary brain tumours), Vestibular schwannoma (acoustic neuroma), Central nervous system germ cell tumours (germinoma and non-germinomatous), Spinal cord tumours (intramedullary and intradural), WNT-activated medulloblastoma, SHH-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH)
Transsphenoidal selective adenomectomy.
Repeat surgery, radiotherapy, osilodrostat or other cortisol-directed drugs, pasireotide or cabergoline, or bilateral adrenalectomy; temozolomide for aggressive tumours.
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Query for this cancer: (TITLE:"Corticotroph pituitary neuroendocrine tumour" OR ABSTRACT:"Corticotroph pituitary neuroendocrine tumour" OR TITLE:"Cushing disease and silent corticotroph tumour" OR ABSTRACT:"Cushing disease and silent corticotroph tumour" OR TITLE:"Corticotroph tumour" OR ABSTRACT:"Corticotroph tumour" OR TITLE:"Corticotroph tumour Cushing disease, silent corticotroph" OR ABSTRACT:"Corticotroph tumour Cushing disease, silent corticotroph" OR TITLE:"ACTH-secreting pituitary adenoma" OR ABSTRACT:"ACTH-secreting pituitary adenoma" OR TITLE:"Cushing disease" OR ABSTRACT:"Cushing disease") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Corticotroph pituitary neuroendocrine tumour (Cushing disease and silent corticotroph tumour), not a curated reading list.
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Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
Take on an empty stomach or at bedtime to reduce nausea; PJP prophylaxis during concurrent chemoradiation.
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