Case Study 5
Diagnosis of ACTH-Producing Pituitary Tumor
Olivia Sisson, Ashley Sizemore,
Michael Ogletree, Katie Bradley
Results
- Thyroid panel
- Normal
- TSH: 0.5-6 uU/mL; T4: 0.5-12 ug/dL
- Observed
- TSH: 4.7 uU/mL; T4: 5.24 ug/dL
- Blood glucose
- Normal: 80-120 mg/dL
- Observed: 125 mg/dL
Results
- Dexamethasone Suppression Test
- Low dose
- Normal: <50 nmol/L
- Observed: 75 nmol/L
- High dose
- Normal: <50 nmol/L
- Observed: 35 nmol/L
- Salivary cortisol
- 8:00 am
- Normal: 10-25 nmol/L
- Observed: 33.2 nmol/L
- 12:00 pm
- Normal: 10-20 nmol/L
- Observed: 28 nmol/L
- 7:00 pm
- Normal: 8-18 nmol/L
- Observed: 22.6 nmol/L
Complaints from Patient
Testing
- Rapid weight gain
- Headaches
- Thyroid panel
- Blood glucose
- Salivary cortisol
- Dexamethasone suppression
Diagnoses Revisited
- Differential diagnosis
- Tests ran for differential diagnosis
- Further research of diseases
- Cushing Syndrome
- Other test ran for Cushing Syndrome
- Cause?
- Feedback loop explains the cause
About the Patient
Differential Diagnoses
- Hypothyroidism
- Diabetes
- Depression
- Hypertension
Treatment Options
Physical Exam
- HR: 78 beats per min
- RR: 15 breaths per min
- BP: 170/104
- Stretch marks
Crainiotomy
vs.
Transnasal transphenoidal resection
Treatment Considerations
- Surgeon experience and availability
Treatment
- Transnasal transphenoidal resection
Sources
What if?
http://www.medicinenet.com/script/main/art.asp?articlekey=53304
http://emedicine.medscape.com/article/2233083-overview#a4
http://www.ncbi.nlm.nih.gov/pubmed/12213667
https://www.healthtap.com/topics/endoscopic-transsphenoidal-resection-of-pituitary-tumor
We find remaining tumor portions?
Follow up
Patient contracts Diabetes Insipidus?
Hormone levels never return to normal?
- Follow up with a neurologist