article = {JSCR-2026-1-101}
title = {Atypical Manifestation of Pituitary Crooke’s Cell Tumor: A Case Report and Literature Review}
journal = {Surgery Case Reports}
year = {2026}
issn = {2733-225X}
doi = {http://dx.doi.org/10.31487/j.JSCR.2026.01.01}
url = {https://www.sciencerepository.org/atypical-manifestation-of-pituitary_JSCR-2026-1-101 
author = {Athary Saleem,Mariam  Alsheikh,Abdullah  Alsayedomar,Mohamad  Alkaak,Maryam  Almurshed,Mohammad  Ghorbani,Tarik Alsheikh,}
keywords = {Pituitary adenoma, Crooke’s cell adenoma, ACTH-producing adenoma, endoscopic transsphenoidal trans-nasal approach, Cushing disease}
abstract ={Background: Crooke’s cell adenoma (CCA) is an unusual and aggressive subtype of corticotroph pituitary adenoma. It accounts for 0.03% of all pituitary adenomas.
Case Presentation: A 29-year-old female patient, with background history of hypertension and hypothyroidism, presented with 14 days history of generalized fatigue and left sided abdominal pain that were recently worsened with headache. The physical examination was unremarkable. Laboratory investigations showed elevated Adrenocorticotropic hormone (ACTH) levels. Despite normal head CT, MRI pituitary showed pituitary macroadenoma. Then, endoscopic trans nasal surgical resection of ACTH-producing pituitary macroadenoma was performed. Diagnosis of Crooke’s cell adenoma was confirmed with histopathology studies. The postoperative course was uneventful.
Discussion: Crooke's cell adenomas are an uncommon form of pituitary tumor. They either produce adrenocorticotropic hormone, which causes Cushing's disease, or they remain unfunctional. These lesions are typically invasive, demonstrating tumors aggressive behavior, and can recur with a low cure rate following reoperation and/or radiotherapy. Rarity of CCA makes determining clinical prognosis and treatment challenging. The novelty of the current case lies in young age of presentation, shirt symptomatic duration, and initially unremarkable CT findings despite biochemical hypercortisolism and elevated ACTH levels.
Conclusion: Due to the rare entity of Crooke’s cell adenoma, we report a 29-year-old female, with Cushing disease, who presented with generalized fatigue and left sided abdominal pain, found to be Crooke’s cell adenoma. This case highlight the importance of maintaining a high index of suspension for functioning pituitary adenoma in patient with non-specific symptoms and normal initial imaging.}