Cushing’s disease is caused by an ACTH-producing pituitary tumor, and accounts for 10–15% of pituitary tumors. The majority
of corticotroph tumors are microadenomas (<10 mm), and accurate histologic identification of these tumors can be challenging
because of their small size and the presence of nests of normal corticotroph cells in the anterior pituitary. Retinoic acid
has been shown to inhibit ACTH production and induce apoptosis in corticotroph tumor cells. The expression of the orphan nuclear
receptor COUP-TFI antagonizes retinoic acid signaling and has been shown to be expressed in normal corticotroph cells, but
absent in corticotroph tumor cell lines. We analyzed 34 corticotroph tumor specimens by immunohistochemistry using a goat
polyclonal IgG antibody with epitope mapping to the N-terminus of human COUP-TFI. Segments of normal pituitary in each of
the 34 specimens demonstrate COUP-TFI immunoreactivity in normal corticotroph cells. Twenty-nine of 34 ACTH producing tumors
were immunonegative for COUP-TFI. All of the tumors measuring less than 5 mm by preoperative MRI were COUP-TFI immunonegative.
Two tumors, measuring 9 and 11 mm, showed consistent (>90%) expression of COUP-TFI, and three adenomas (5, 11, and 18 mm)
showed heterogenous (20–80%) expression of COUP-TFI. Immunohistochemistry of COUP-TFI may be a useful adjuvant diagnostic
tool in distinguishing corticotroph microadenomas from nests of normal corticotroph cells in the anterior pituitary. Furthermore,
this study identifies two unique corticotroph tumor populations which differ in their expression of COUP-TFI, the presence
of which occurs more frequently in macroadenomas.
Keywords Cushing’s - COUP-TFI - Diagnosis - Pathology - Corticotroph