{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:34:01Z","timestamp":1787582041175,"version":"build-2736575974"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T00:00:00Z","timestamp":1619827200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T00:00:00Z","timestamp":1619827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Patients with Crooke cell tumours present with features of Cushing syndrome or mass effect. There are few reports of patients with Crooke cell tumours presenting due to apoplexy. All of them had silent tumours. Patients with Cushing syndrome caused by Crooke cell tumours have not been reported to present with apoplexy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 35-year-old female presented with sudden onset headache and visual loss for 1 week. She had secondary amenorrhoea for 10\u2009years. There were features of Cushing syndrome including central obesity, multiple monomorphic acne, dorso-cervical and supraclavicular fat pads, hypertension, proximal weakness, pigmentation and refractory hypokalaemia. She was found to have markedly elevated serum cortisol, central hypothyroidism and hypogonadotropic hypogonadism. There was a mass in the sellar region (4.7\u2009cm\u2009\u00d7\u20091.9\u2009cm\u2009\u00d7\u20095.3\u2009cm) suggestive of a pituitary tumour extending to the suprasellar region. Imaging showed evidence of bleeding and compression of the optic chiasm. She underwent urgent trans-sphenoidal excision of the tumour. Histology was compatible with a pituitary neuroendocrine tumour. There was margination of ACTH reactivity to the cell periphery and ring like positivity in most of the cells in the cytokeratin stain. Features were in favour of a Crooke cell tumour. After surgery she improved gradually and became eucortisolaemic.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This is a unique presentation of an apoplexy of Crooke cell tumour causing Cushing syndrome. Delayed health seeking behaviour of this patient despite severe Cushing disease could have led to this presentation which has not been reported before.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12902-021-00761-2","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T12:08:01Z","timestamp":1620043681000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Apoplexy of Crooke cell tumour leading to the diagnosis of severe Cushing disease; a case report"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4467-3659","authenticated-orcid":false,"given":"Nipun Lakshitha","family":"de Silva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6241-7501","authenticated-orcid":false,"given":"Noel","family":"Somasundaram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshana","family":"Constantine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Himashi","family":"Kularatna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,1]]},"reference":[{"issue":"10","key":"761_CR1","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.1097\/00000478-200310000-00005","volume":"27","author":"DH George","year":"2003","unstructured":"George DH, Scheithauer BW, Kovacs K, Horvath E, Young WF, Lloyd RV, et al. Crooke\u2019s cell adenoma of the pituitary: an aggressive variant of corticotroph adenoma. Am J Surg Pathol. 2003;27(10):1330\u20136. https:\/\/doi.org\/10.1097\/00000478-200310000-00005.","journal-title":"Am J Surg Pathol"},{"issue":"5","key":"761_CR2","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1227\/NEU.0000000000000657","volume":"76","author":"A Di Ieva","year":"2015","unstructured":"Di Ieva A, Davidson JM, Syro LV, Rotondo F, Montoya JF, Horvath E, et al. Crooke's cell tumors of the pituitary. Neurosurgery. 2015;76(5):616\u201322. https:\/\/doi.org\/10.1227\/NEU.0000000000000657.","journal-title":"Neurosurgery."},{"issue":"12","key":"761_CR3","doi-asserted-by":"publisher","first-page":"1274","DOI":"10.4158\/EP14120.OR","volume":"20","author":"G Vargas","year":"2014","unstructured":"Vargas G, Gonzalez B, Guinto G, Mendoza V, Lopez-Felix B, Zepeda E, et al. Pituitary apoplexy in nonfunctioning pituitary macroadenomas: a case-control study. 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Endocr Pathol. 2002;13(3):245\u20139. https:\/\/doi.org\/10.1385\/EP:13:3:245.","journal-title":"Endocr Pathol"},{"issue":"2","key":"761_CR8","doi-asserted-by":"publisher","first-page":"e150","DOI":"10.4158\/ACCR-2018-0347","volume":"5","author":"KJ Khatri","year":"2019","unstructured":"Khatri KJ, Javanmard P, Pawha PS, Miller JD. Clinically silent adrenocorticotropic hormone-secreting crooke cell adenoma presenting as unilateral ear pain. AACE Clin Case Rep. 2019;5(2):e150\u20133. https:\/\/doi.org\/10.4158\/ACCR-2018-0347.","journal-title":"AACE Clin Case Rep"},{"key":"761_CR9","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1016\/j.wneu.2018.10.232","volume":"122","author":"RG Krug 2nd","year":"2019","unstructured":"Krug RG 2nd, Chang AY, Raghunathan A, Van Gompel JJ. Apoplectic silent Crooke cell adenoma with adjacent Pseudoaneurysms: causation or bystander? 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A copy of the written consent is available for review by the Editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All the authors declare that there is no conflict of interest regarding the publication of this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"93"}}