Corticotroph cell adenoma without typical manifestations of Cushing's disease presenting with cavernous sinus syndrome following pituitary apoplexy

This report presents a unique case of corticotroph cell adenoma in a 30-yea r-old man without acromegaly or features typical of Cushing's disease, who developed cavernous sinus syndrome following pituitary apoplexy. Magnetic r esonance imaging revealed a large intrasellar/suprasellar mass with pituita ry hemorrhage and extension of a hematoma to the anterior base of the skull . Urgent transnasal pituitary surgery revealed an acidophilic pituitary ade noma, with immunoreactivity for ACTH and GH and expression of proopiomelano cortin (POMC) and GH messenger ribonucleic acid (mRNA) demonstrated by in s itu hybridization. To our knowledge, a silent corticotroph cell adenoma wit h GH production has never been reported. This type of adenoma may potential ly enlarge and develop tumoral hemorrhage because it is free of endocrinolo gical symptoms.