A 35-year-old woman with Cushing disease has a pituitary microadenoma secreting ACTH. Histologically, the adenoma cells show characteristic 'Crooke hyaline change' in surrounding non-adenomatous corticotrophs. This change represents:
- A Amyloid deposition in pituitary cells from excessive ACTH precursor processing
- B Intracellular accumulation of fibrous bodies (intermediate filaments/CK8) displacing secretory granules due to excess cortisol feedback ✓
- C Colloid accumulation due to reduced ACTH secretion in non-adenomatous cells
- D Vacuolar degeneration of corticotrophs due to excess CRH stimulation
Explanation
Crooke hyaline change is a specific pathological finding in non-adenomatous corticotrophs (and in rare Crooke cell adenomas) in patients with hypercortisolism. Excess glucocorticoids cause accumulation of CK8/CK18 intermediate filaments (perinuclear hyaline material) that displace secretory granules to the cell periphery, producing the characteristic 'ring-like' ACTH staining pattern. It reflects negative feedback of cortisol on pituitary ACTH production. Crooke cells on IHC show ring-pattern ACTH and CK8 positivity. Crooke cell adenoma is an aggressive variant with predominant Crooke cells.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.