This study analysed diagnostic features, surgical therapy, and clinical outcomes in individuals with Cushing disease to compare corticotroph hyperplasia with histopathologically confirmed adenomas. Patients with probable pituitary Cushing illness were included in a retrospective cohort study. Patients were ruled out if the surgical specimen’s pathological investigation came back as nondiagnostic or normal. Total lesion removal was defined as an extracapsular excision (including a rim of normal gland) in individuals with a total lesion. It was also defined for hyperplasia patients as the excision of the suspected lesion as well as a rim of surrounding normal gland. The two groups were compared in terms of recurrence-free survival. The final cohort consisted of 63 patients (15 with hyperplasia and 48 with adenoma) Normal pituitary acinar architecture was highly variable. Corticotroph hyperplia was diagnosed based on the presence of expanded acini showing retained reticulin architecture and predominant staining for adrenocorticotropic hormone. This research reveals a link between Cushing disease with biochemical evidence and corticotroph hyperplasia with histological evidence. The surgical approach is more subtle than for ordinary adenomas with a pseudocapsule, and imaging and operational findings can be unclear. However, if properly treated, biochemical consequences may be identical.

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