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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

CT scan ordered

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

  • Tumor size
  • Age of patient
  • Surgeon experience and availability
  • Urgency

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?

  • Hormone testing
  • CT scan
  • Follow up with a neurologist
  • Radiation therapy
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