Silent corticotroph adenomas are pituitary tumors of corticotroph lineage that are not associated with biochemical or clinical findings of hypercortisolism. We present the case of a 35-year-old male patient with a history of a non-functional pituitary macroadenoma initially diagnosed in 2007 and with the last pathology of 2018 confirming a corticotroph adenoma most likely of the densely granulated subtype. The patient has undergone 4 surgical procedures and received radiotherapy. There is positivity for ACTH in immunohistochemistry and elevation of ACTH in plasma, however, in the absence of clinical or biochemical signs of hypercortisolism, a diagnosis of a silent corticotroph adenoma was considered. The tumor has exhibited an aggressive behavior during follow-up, with invasion to surrounding structures and in the last pathology there is evidence of high proliferation. A review of the characteristics of this histological variant and the available therapeutic options is done
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