Cushing it uphill: a Sisyphean case
|
|
|
- Jerome Dalton
- 5 years ago
- Views:
Transcription
1 Sunita MC De Sousa Ann I McCormack St Vincent s Hospital, Sydney ESA Clinical Weekend 2014 Cushing it uphill: a Sisyphean case
2 None Declarations of interests
3 27 F, engaged to be married Weight gain, fatigue, insomnia, hirsutism, acne, sweating, galactorrhoea early 2011 No FHx of endocrine neoplasia Weight gain, hirsutism, fatigue 2008 bilateral ovarian dermoid cysts Respiratory, neurological & thyroid tissue Symptoms resolved with resection
4 Biochemical evaluation 24-UFC 811 nmol/d (54-319) ACTH 10.7 pmol (0-12.0) PRL 794 miu/l (85-500) No suppression on 1mg overnight dex test Normalised on cabergoline TSH 0.37 miu/l ( ) ft pmol/l ( ) ft3 4.5 pmol/l ( ) Normalised spontaneously IGF-1 55 nmol (15-43) GH suppressed on OGTT
5 MRI 1, Oct 2011
6 MRI 1, Oct 2011 Declined IPSS
7 ACTH stain 2008 dermoid cyst negative Ovarian vein sampling no gradient Repeat ovarian cystectomy Aug 2012
8 MRI 2, Oct 2012 Declined IPSS
9 TSS Nov 2012 Normal pituitary
10 Ongoing hypercortisolism Mar 2013 Modest weight loss, remained Cushingoid 24-UFC 1159 nmol/d ACTH 11.7 pmol/l Agreed to IPSS
11 IPSS Apr 2013 Rt IPS : periph ACTH = 8 (>2) Corrected for PRL = (>0.8) R IPS L high jugular V Peripheral ACTH pg/ml PRL miu/l No ectopic source on CT chest/abdomen
12 Rpt TSS Jun 2013 Pituitary hyperplasia
13 Ongoing hypercortisolism Sept UFC 1491 nmol/d ACTH 18 pmol/l Commenced ketoconzaole / cabergoline Reference Dec 2013 Elevation above ULN RIA x HPLC x
14 MRI 4, Dec 2013
15 MRI 1, Oct 2011 MRI 2, Oct 2012 MRI 3, Mar 2013 MRI 4, Dec 2013
16 Emerging hypopituitarism Jan 2014 Reference E2 pmol/l 55 LH IU/L 4.3 FSH IU/L 6.9 IGF-1 nmol/l GH miu/l < TSH miu/l ft4 pmol/l Oligomenorrhoea, osteopenia HRT commenced
17 What is the diagnosis? What is the treatment?
18 Intraoperative smears 2012, 2013?Adenoma
19 Ovarian teratoma tissue 2012?Ectopic CRH syndrome
20 9 8.5 ketoconazole 400 BD 200 BD 300 BD metformin 1000 nocte cabergoline 0.5 wkly pasireotide 600 BD 900 BD UFC xuln HbA1c (%) f'bsl (mmol/l) RTx Deferred family planning 0 25-Sep 25-Oct 25-Nov 25-Dec 25-Jan 25-Feb 25-Mar 25-Apr 25-May 25-Jun 25-Jul
21 Issues Identification of the cause of ACTHdependent hypercortisolism Management of refractory Cushing s disease Impact of Cushing s syndrome on reproductive health
22 Cushing s syndrome 20% ACTHindependent 80% ACTHdependent 80% Pituitary 20% Ectopic (EAS) Pituitary adenoma (CD) Pituitary hyperplasia Carcinoid/NET Newell-Price 2011 Newell-Price et al 2006 Ectopic CRH (ECS) SCLC
23 Clues to EAS Higher UFC Hypokalaemia SCLC rapid onset Myopathy Hyperpigmentation Absence of wt gain, fat redistribution Invitti et al 1999 Ilias et al 2005 Newell-Price 2011 Newell-Price et al 2006
24 Tumours with isolated CRH n Medullary thyroid cancer 7 Phaeochromocytoma 4 Prostate cancer 3 Intrasellar gangliocytoma 3 SCLC 2 SCC (unknown primary) 2 Bronchial carcinoid 1 Clues to ECS Evidence of primary tumour Pituitary hyperplasia High-normal plasma CRH Varying dynamic test results Shahani et al 2010 Wajchenbger et al 1995
25 Localisation to the pituitary MRI HDDST CRH test No tumour visible in 40% 20% CD don t suppress 10% CD don t stimulate 10% incidentaloma High specificity 80% a priori risk of pituitary source Newell-Price et al mm adenoma on MRI + suppression on HDDST + stimulation on CRH IPSS not necessary
26 Histopathological diagnosis of CD Intraoperative assessment Freezing cellular artifact Smearing disrupts architecture May wholly contain tumour Adenoma in 96% smears vs 69% paraffin block Kurosaki et al 2000
27 Management of refractory CD TSS: 69-93% at initial, 20-77% at rpt BLA: Nelson s in 8-38% Radiosurgery: 17-54% Vs conventional RTx Efficient Quick onset Similar cure rate?less hypopituitarism Aghi 2008
28 Cabergoline Aghi 2008
29 New kids Pasireotide SSA, especially SSTR 5 Normalised UFC at 6mo in 15-26% New-onset DM (48%) Diarrhoea (58%) LCI699 Potent 11β-Ohase inhibitor Substantial UFC in 12/12 Wt gain (3.5 kg) Hypokalaemia (4/12) BP (10/6 mmhg) Colao et al 2012 Bertagna et al 2014
30 Hypercortisolism & fertility 80% of hypercortisolaemic women have oligo/amenorrhoea 10% 3% 2% 3% 33% CD EAS AA 12% 10% 1% 2% CD 8% 67% EAS AA Adrenal Ca MAH Adrenal Ca Other 46% Lindsay et al % AIH Other Unknown Difficult to diagnose serum cortisol, CBG, UFC Placental CRH Lactotroph hyperplasia Orth 1995
31 Reproductive outcomes Maternal morbidity Fetal morbidity HTN (68%) Prematurity (43%) Diabetes, IGT (25%) IUGR (21%) Preeclampsia (14%) Stillbirth (6%) Osteoporosis, fracture (5%) Miscarriage (5%) Psychiatric disorders (4%) Hypoadrenalism (2%) Cardiac failure (3%) Wound infection (2%) 2 cases of neonatal death, intraventricular haemorrhage Maternal death (2%) Single cases of cleft lip, PDA, CoA Lindsay et al 2005
32 CD TSS Management of refractory CD in pregnancy?? Rpt TSS BLA RTx Medical Rx Ketoconazole Metyrapone Pasireotide Mitotane LCI699 RU-486 Lindsay et al 2005
33 Key points 1. CD is difficult to diagnose and manage, therefore best treated in multidisciplinary setting 2. CD is the commonest cause of hypercortisolism, but beware clues to EAS & ECS 3. Increasing options in medical therapy may affect treatment paradigms in the future 4. Hypercortisolism is associated with significant maternal & fetal morbidity, and pregnancy may be best deferred
34 References Newell-Price J. Cushing s syndrome. In: Wass JAH, Stewart PM, Amiel SA, et al. Oxford Textbook of Endocrinology and Diabetes. 2 nd Ed. Oxford, UK: Oxford University Press; p Newell-Price J, Bertagna X, Grossman AB, et al. Cushing s syndrome. Lancet 2006;367: Ilias I, Torpy DJ, Pacak K, et al. Cushing's syndrome due to ectopic corticotropin secretion: twenty years' experience at the National Institutes of Health. J Clin Endocrinol Metab 2005;90: Invitti C, Giraldi FP, De Martin M, et al. Diagnosis and management of Cushing s syndrome: results of an Italian multicentre study. J Clin Endocrinol Metab 1999;84: Shahani S, Nudelman RJ, Nalini R, et al. Ectopic corticotropin-releasing hormone syndrome from metastatic small cell carcinoma: a case report and review of the literature. Diagn Pathol 2010;5: Wajchenberg BL, Mendonca B, Liberman B, et al. Ectopic ACTH syndrome. J Steroid Biochem Mol Biol 1995;53: Kurosaki M, Luedecke DK, Knappe UJ et al. The Value of Intraoperative Cytology During Transsphenoidal Surgery for ACTH-Secreting Microadenoma. Acta Neurochir (Wien) 2000;142: Aghi MK. Management of recurrent and refractory Cushing disease. Nat Clin Pract Endocrinol Metab 2008;4: Bertagna X, Pivonello R, Fleseriu M et al. LCI699, a Potent 11β-hydroxylase Inhibitor, Normalizes Urinary Cortisol in Patients With Cushing s Disease: Results From a Multicenter, Proof-of-Concept Study. J Clin Endocrinol Metab 2014;99: Lindsay JR, Jonklaas J, Oldfield EH, et al. Cushing s syndrome during pregnancy: personal experience and review of the literature. J Clin Endocrinol Metab 2005;90: Orth DN. Cushing s syndrome. N Engl J Med 1995;332:
35 Acknowledgements Thank you to Clinicians sharing in patient care: A/Prof Tony O Sullivan, Dr Mridula Lewis, A/Professor Robert Smee, Dr Mark Davies Prof Roger Smith for CRH staining Dr Anita Muljono for ACTH staining Dr Yael Barnett for MRI review
36 Supplementary slides
37 Crooke s hyaline change Crooke 1935
38 CRH in the skin Ito et al 2005
39 Substantial UFC reduction in 50% Colao et al 2012
40 Substantial UFC reduction in all Bertagna et al 2014
41 Other steroidogenic effects of LCI699 Bertagna et al 2014
CUSHING SYNDROME Dr. Muhammad Sarfraz
Indep Rev Jul-Dec 2018;20(7-12) CUSHING SYNDROME Dr. Muhammad Sarfraz IR-655 Abstract: It is defined as clinical condition in which there are increased free circulating glucocorticoides casused by excessive
Therapeutic Objectives. Cushing s Disease Surgical Results. Cushing s Disease Surgical Results: Macroadenomas 10/24/2015
Therapeutic Objectives Update on the Management of Lewis S. Blevins, Jr., M.D. Correct the syndrome by lowering daily cortisol secretion to normal Eradicate any tumor that might threaten the health of
C h a p t e r 3 8 Cushing s Syndrome : Current Concepts in Diagnosis and Management
C h a p t e r 3 8 Cushing s Syndrome : Current Concepts in Diagnosis and Management Padma S Menon Professor of Endocrinology, Seth G S Medical College & KEM Hospital, Mumbai A clinical syndrome resulting
TREATMENT OF CUSHING S DISEASE
TREATMENT OF CUSHING S DISEASE Surgery, Radiation, Medication Peter J Snyder, MD Professor of Medicine Disclosures Novartis Research grant Pfizer Consultant Ipsen Research grant Cortendo Research grant
Endocrine Topic Review. Sethanant Sethakarun, MD
Endocrine Topic Review Sethanant Sethakarun, MD Definition Cushing's syndrome comprises a large group of signs and symptoms that reflect prolonged and in appropriately high exposure of tissue to glucocorticoids
Female Reproductive Endocrinology
Female Reproductive Endocrinology Dr. Channa Jayasena PhD MRCP FRCPath Clinical Senior Lecturer & Consultant Endocrinologist Department of Gynaecology, Hammersmith Hospital Anovulation is a common cause
Pituitary for the General Practitioner. Marilyn Lee Consultant physician and endocrinologist
Pituitary for the General Practitioner Marilyn Lee Consultant physician and endocrinologist Pituitary tumours Anterior/posterior pituitary Extension of adenoma upwards/downwards/sideways Producing too
Differential Diagnosis of Cushing s Syndrome
Differential Diagnosis of Cushing s Syndrome Cushing s the Diagnostic Challenge Julia Kharlip, MD and Caitlin White, MD Endocrinology, Diabetes and Metabolism Perelman School of Medicine at the University
Pituitary Adenomas: Evaluation and Management. Fawn M. Wolf, MD 10/27/17
Pituitary Adenomas: Evaluation and Management Fawn M. Wolf, MD 10/27/17 Over 18,000 pituitaries examined at autopsy: -10.6% contained adenomas (1.5-27%) -Frequency similar for men and women and across
AVS and IPSS: The Basics and the Pearls William F. Young, Jr., MD, MSc Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA
AVS and IPSS: The Basics and the Pearls William F. Young, Jr., MD, MSc Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA 2016 Mayo Foundation for Medical Education and Research.
David Henley. Sir Charles Gairdner Hospital, Nedlands WA University of Western Australia. ESA Seminar Weekend, Melbourne Vic 27 th May 2017
David Henley Sir Charles Gairdner Hospital, Nedlands WA University of Western Australia ESA Seminar Weekend, Melbourne Vic 27 th May 2017 Disclosures Received honoraria from Ipsen, Novartis, Servier, Bristol-Myers
Cortisol levels. Naturally produced by the adrenal Cortisol
1 + 2 Cortisol levels asleep awake Naturally produced by the adrenal Cortisol Man made tablets, injections, creams & inhalers Cortisone Hydrocortisone Prednisone Prednisolone Betamethasone Methylprednisolone
Approach to Adrenal Incidentaloma. Alice Y.Y. Cheng, MD, FRCP
Approach to Adrenal Incidentaloma Alice Y.Y. Cheng, MD, FRCP Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form
I farmaci ad azione surrenalica: METIRAPONE ed OSILODROSTAT
I farmaci ad azione surrenalica: METIRAPONE ed OSILODROSTAT Maria Cristina De Martino Dipartimento di Medicina Clinica e Chirurgia Sezione di Endocrinologia, Università Federico II di Napoli, Italy 1 Treatment
Index. F Fatigue, 59 Food-dependent Cushing s syndrome, 286
A Abdominal red striae, 57, 58 Aberrant hormone receptors, AIMAH familial forms, 215 investigative protocols, 217 218 molecular mechanisms, 216, 217 paracrine mechanisms, 216 steroidogenesis, 212 213 in
ACTH-dependent Cushing s Syndrome Update AACE MI Chapter Annual Meeting September 22, Lynnette K. Nieman DEOB, NIDDK, NIH, DHHS
ACTH-dependent Cushing s Syndrome Update AACE MI Chapter Annual Meeting September 22, 2018 Lynnette K. Nieman DEOB, NIDDK, NIH, DHHS Objectives At the conclusion of this presentation, participants should
Pituitary Gland Disorders
Pituitary Gland Disorders 1 2 (GH-RH) (CRH) (TRH) (TRH) (GTRH) (GTRH) 3 Classification of pituitary disorders: 1. Hypersecretory diseases: a. Acromegaly and gigantism: Usually caused by (GH)-secreting
CUSHING S SYNDROME. Australian Endocrine Society, May 26 th 2017
CUSHING S SYNDROME Ashley Grossman FMedSci Green-Templeton College, University of Oxford, Royal Free Hospital, London Barts and the London School of Medicine, London Australian Endocrine Society, May 26
2
1 2 General % Obesity 90 Hypertension 85 Skin Plethora 70 Hirsutism/hair loss 75 Striae 50 Acne 35 Bruising/thinning 35 Musculoskeletal Osteopenia/porosis 80 Weakness 65 Neuropsych % Lability,euphoria,insomnia,
Adrenal incidentaloma guideline for Northern Endocrine Network
Adrenal incidentaloma guideline for Northern Endocrine Network Definition of adrenal incidentaloma Adrenal mass detected on an imaging study done for indications that are not related to an adrenal problem
Clinical Study Clinical Characteristics of Endogenous Cushing s Syndrome at a Medical Center in Southern Taiwan
International Endocrinology Volume 2013, Article ID 685375, 7 pages http://dx.doi.org/10.1155/2013/685375 Clinical Study Clinical Characteristics of Endogenous Cushing s Syndrome at a Medical Center in
Cushing s Syndrome. Diagnosis. GuidelineCentral.com. Key Points. Diagnosis
Cushing s Syndrome Consultant: Endocrine Society of Cushing s Syndrome Clinical Practice Guideline Writing Committee Key Points GuidelineCentral.com Key Points The most common cause of Cushing s syndrome
14 Girl with Cushing s Disease: An Update. Kristen Dillard, MD Endorama October 17, 2013
14 Girl with Cushing s Disease: An Update Kristen Dillard, MD Endorama October 17, 2013 Initial Presentation Pt initially presented to pediatrician for school physical in fall 2012. Pt was found to be
Subclinical Cushing s Syndrome
Subclinical Cushing s Syndrome AACE 26th Annual Scientific & Clinical Congress Associate Clinical Professor of Medicine and Clinical Chief University of Miami Miller Scholl of Medicine Miami, Florida aayala2@miami.edu
October 13, Surgical Nuances to Managing Cushing s Disease. Cortisol Regulation. Cushing s Syndrome Excess Cortisol. Sandeep Kunwar, M.D.
Surgical Nuances to Managing Cushing s Disease Cortisol Regulation Sandeep Kunwar, M.D. Surgical Director, California Center for Pituitary Disorders Associate Clinical Professor, University of California,
Dr John Quin. Royal Sussex County Hospital, Brighton. BHIVA AUTUMN CONFERENCE 2013 Including CHIVA Parallel Sessions. None
BHIVA AUTUMN CONFERENCE 2013 Including CHIVA Parallel Sessions Dr John Quin Royal Sussex County Hospital, Brighton COMPETING INTEREST OF FINANCIAL VALUE > 1,000: Speaker Name Statement Dr John Quin None
Clinical Commissioning Policy Proposition: Pasireotide: An injectable medical therapy for the treatment of Cushing's disease
Clinical Commissioning Policy Proposition: Pasireotide: An injectable medical therapy for the treatment of Cushing's disease Information Reader Box (IRB) to be inserted on inside front cover for documents
ADVANCES IN MANAGING CUSHING S DISEASE. Rosario Pivonello Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
ADVANCES IN MANAGING CUSHING S DISEASE Rosario Pivonello Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy Patients with persistent Cushing s disease have higher morbidity
AVS and IPSS: The Basics and the Pearls
AVS and IPSS: The Basics and the Pearls William F. Young, Jr., MD, MSc Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA 2018 Mayo Foundation for Medical Education and Research.
CUSHING'S SYNDROME. Bharath University, Chrompet, Chennai, Tamil Nadu, India
TJPRC: International Journal of Nursing and Patient Safety & Care (TJPRC: IJNPSC) Vol. 1, Issue 1, Jun 2016, 57-62 TJPRC Pvt. Ltd. CUSHING'S SYNDROME R. RAMANI 1 & V. HEMAVATHY 2 1 Associate Professor,
Challenging Pituitary Cases. Laurence Katznelson, MD Professor of Medicine and Neurosurgery Stanford University School of Medicine
Challenging Pituitary Cases Laurence Katznelson, MD Professor of Medicine and Neurosurgery Stanford University School of Medicine 1 34 yo male has incidental finding of large macroadenoma, with prolactin
Case Report Metyrapone for Long-Term Medical Management of Cushing s Syndrome
Case Reports in Endocrinology Volume 2013, Article ID 782068, 4 pages http://dx.doi.org/10.1155/2013/782068 Case Report Metyrapone for Long-Term Medical Management of Cushing s Syndrome Andrea N. Traina,
Professor Ian Holdaway. Endocrinologist Auckland District Health Board
Professor Ian Holdaway Endocrinologist Auckland District Health Board A land of milk and giants hormonesecreting pituitary tumours I M Holdaway, Endocrinologist, Auckland Acromegaly Prolactinomas Cushing
Neuroendocrine Disorders in Women
Neuroendocrine Disorders in Women Ursula B. Kaiser, M.D. Chief, Division of Endocrinology, Diabetes and Hypertension Brigham and Women s Hospital Professor of Medicine, Harvard Medical School Case Presentation
MILD HYPERCORTISOLISM DUE TO ADRENAL ADENOMA: IS IT REALLY SUBCLINICAL?
MILD HYPERCORTISOLISM DUE TO ADRENAL ADENOMA: IS IT REALLY SUBCLINICAL? Alice C. Levine, MD Professor of Medicine Division of Endocrinology, Diabetes and Bone Diseases Georgia-AACE 2017 Annual Meeting
Undetectable postoperative cortisol does not always. predict long-term remission in Cushing s disease: a single centre audit*
Clinical Endocrinology (2002) 56, 25 31 Undetectable postoperative cortisol does not always Blackwell Science Ltd predict long-term remission in Cushing s disease: a single centre audit* L. B. Yap*, H.
Challenges in the diagnosis and management of Cushing s syndrome due to ectopic ACTH from bronchial carcinoid
Challenges in the diagnosis and management of Cushing s syndrome Challenges in the diagnosis and management of Cushing s syndrome due to ectopic ACTH from bronchial carcinoid M S A Cooray 1, N P Somasundaram
Introduction to Endocrinology. Hypothalamic and Pituitary diseases Prolactinoma + Acromegaly
Introduction to Endocrinology. Hypothalamic and Pituitary diseases Prolactinoma + Acromegaly Dr. Peter Igaz MD PhD DSc 2nd Department of Medicine Semmelweis University Fields of Endocrinology Diseases
CUSHING S SYNDROME THE FACTS YOU NEED TO KNOW
CUSHING S SYNDROME THE FACTS YOU NEED TO KNOW Written by: Paul Margulies, MD, FACE, FACP, Medical Director, NADF. Clinical Associate Professor of Medicine, Zucker School of Medicine at Hofstra/Northwell.
High and Low GH: an update of diagnosis and management of GH disorders
High and Low GH: an update of diagnosis and management of GH disorders Georgia Chapter-AACE 2017 Laurence Katznelson, MD Professor of Medicine and Neurosurgery Associate Dean of Graduate Medical Education
Pituitary Tumors and Incidentalomas. Bijan Ahrari, MD, FACE, ECNU Palm Medical Group
Pituitary Tumors and Incidentalomas Bijan Ahrari, MD, FACE, ECNU Palm Medical Group Background Pituitary incidentaloma: a previously unsuspected pituitary lesion that is discovered on an imaging study
False-positive inferior petrosal sinus sampling in the diagnosis of Cushing s disease
J Neurosurg 83:1087 1091, 1995 False-positive inferior petrosal sinus sampling in the diagnosis of Cushing s disease Report of two cases YOSHIHIRO YAMAMOTO, M.D., D.M.SC., DUDLEY H. DAVIS, M.D., TODD B.
Laura Stewart, MD, FRCPC Clinical Associate Professor Division of Pediatric Endocrinology University of British Columbia
Precocious Puberty Laura Stewart, MD, FRCPC Clinical Associate Professor Division of Pediatric Endocrinology University of British Columbia Faculty Disclosure Faculty: Laura Stewart No relationships with
GLMS CME- Cell Group 5 10 April Greenlane Medical Specialists Pui-Ling Chan Endocrinologist
GLMS CME- Cell Group 5 10 April 2018 Greenlane Medical Specialists Pui-Ling Chan Endocrinologist Pituitary case one Mrs Z; 64F Seen ORL for tinnitus wax impaction MRI Head Pituitary microadenoma (3mm)
Endocrine Testing. Alice Y.Y. Cheng, MD, FRCP October 14, 2015
Endocrine Testing Alice Y.Y. Cheng, MD, FRCP October 14, 2015 Disclosure No disclosures relevant to the content of this workshop Learning Objectives By the end of this workshop, you will be able to: 1.
Original Research Article
Medrech ISSN No. 2394-3971 Original Research Article TYPE 2 DIABETES WITH RECURRENT OSTEOPOROTIC FRACTURES, OR CUSHING S SYNDROME? Blertina Dyrmishi¹*; Taulant Olldashi²; Prof Asc Thanas Fureraj 3 ; Prof
Diagnostic Challenges in Multiple Endocrine Neoplasia Type 1 (MEN1) : Usefulness of Genetic Analysis
Diagnostic Challenges in Multiple Endocrine Neoplasia Type 1 (MEN1) : Usefulness of Genetic Analysis Professor R. V. Thakker, FRS May Professor of Medicine University of Oxford, U.K. Meet The Experts 49
CUSHING S SYNDROME. Chapter 8. Case: A 43-year-old man with delusions
Chapter 8 CUSHING S SYNDROME Case: A 43-year-old man with delusions A previously healthy 43-year-old man is brought to the emergency department for evaluation of confusion. The patient has complained to
CHOLESTEROL IS THE PRECURSOR OF STERIOD HORMONES
HORMONES OF ADRENAL CORTEX R. Mohammadi Biochemist (Ph.D.) Faculty member of Medical Faculty CHOLESTEROL IS THE PRECURSOR OF STERIOD HORMONES CONVERSION OF CHOLESTROL TO PREGNENOLONE MINERALOCORTICOCOIDES
(3) Pituitary tumours
Hypopituitarism Diabetes Insipidus Pituitary tumours (2) Dr T Kemp - Endocrinology and Metabolism Unit - Steve Biko Academic Hospital (3) Pituitary tumours Pituitary microadenoma - intrasellar adenoma
Practical Management of Steroids in Non-Endocrine Practice
Practical Management of Steroids in Non-Endocrine Practice Dr Miguel Debono MD MRCP PhD Consultant Physician in Endocrinology and Honorary Senior Lecturer February 2016 Outline Epidemiology of steroids
Endocrine Emergencies: Recognition and Management
Endocrine Emergencies: Recognition and Management John Wass Department of Endocrinology, Oxford University, UK An Update on Acute Medical Emergencies for Psychiatrists Royal College of Psychiatrists' address
Somatotroph Pituitary Adenomas (Acromegaly) The Diagnostic Pathway (11-2K-234)
Somatotroph Pituitary Adenomas (Acromegaly) The Diagnostic Pathway (11-2K-234) Common presenting symptoms/clinical assessment: Pituitary adenomas are benign neoplasms of the pituitary gland. In patients
ULTIMATE BEAUTY OF BIOCHEMISTRY. Dr. Veena Bhaskar S Gowda Dept of Biochemistry 30 th Nov 2017
ULTIMATE BEAUTY OF BIOCHEMISTRY Dr. Veena Bhaskar S Gowda Dept of Biochemistry 30 th Nov 2017 SUSPECTED CASE OF CUSHING S SYNDROME Clinical features Moon face Obesity Hypertension Hunch back Abdominal
Audit of Adrenal Function Tests. Kate Davies Senior Lecturer in Children s Nursing London South Bank University London, UK
Audit of Adrenal Function Tests Kate Davies Senior Lecturer in Children s Nursing London South Bank University London, UK Introduction Audit Overview of adrenal function tests Education Audit why? Explore
PITUITARY: JUST THE BASICS PART 2 THE PATIENT
PITUITARY: JUST THE BASICS PART 2 THE PATIENT DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none Steps taken to review and
Case Report Pediatric Cushing s Disease and Pituitary Incidentaloma: Is This a Real Challenge?
Case Reports in Endocrinology, Article ID 851942, 5 pages http://dx.doi.org/10.1155/2014/851942 Case Report Pediatric Cushing s Disease and Pituitary Incidentaloma: Is This a Real Challenge? Rosa Maria
William F. Young, Jr., MD, MSc Professor of Medicine, Mayo Clinic, Rochester, MN USA
The Year in Adrenal William F. Young, Jr., MD, MSc Professor of Medicine, Mayo Clinic, Rochester, MN USA Division of ENDOCRINOLOGY, DIABETES, METABOLISM & NUTRITION 2018 Mayo Foundation for Medical Education
Pituitary, Parathyroid Pheochromocytomas & Paragangliomas: The 4 Ps of NETs
Pituitary, Parathyroid Pheochromocytomas & Paragangliomas: The 4 Ps of NETs Shereen Ezzat, MD, FRCP(C), FACP Professor Of Medicine & Oncology Head, Endocrine Oncology Princess Margaret Hospital/University
See the latest estimates for new cases of pituitary tumors in the US and what research is currently being done.
About Pituitary Tumors Overview and Types If you have been diagnosed with a pituitary tumor or worried about it, you likely have a lot of questions. Learning some basics is a good place to start. What
Prolactin-Secreting Pituitary Adenomas (Prolactinomas) The Diagnostic Pathway (11-2K-234)
Prolactin-Secreting Pituitary Adenomas (Prolactinomas) The Diagnostic Pathway (11-2K-234) Common presenting symptoms/clinical assessment: Pituitary adenomas are benign neoplasms of the pituitary gland.
MANAGEMENT OF PATIENTS WITH CUSHING S DISEASE: A CANADIAN COST OF ILLNESS ANALYSIS
MANAGEMENT OF PATIENTS WITH CUSHING S DISEASE: A CANADIAN COST OF ILLNESS ANALYSIS S. Van Uum 1, M. Hurry 2, R. Petrella 1, C. Koch 2, G. Dranitsaris 3, A. Lacroix 4 1 Western University, Schulich School
The biochemical investigation of Cushing syndrome
Neurosurg Focus 16 (4):Article 4, 2004, Click here to return to Table of Contents The biochemical investigation of Cushing syndrome MARIE SIMARD, M.D. Division of Pediatric Endocrinology, Department of
Long-term results of treatment in patients with ACTH-secreting pituitary macroadenomas
European Journal of Endocrinology (2003) 149 195 200 ISSN 0804-4643 CLINICAL STUDY Long-term results of treatment in patients with ACTH-secreting pituitary macroadenomas S Cannavò, B Almoto, C Dall Asta
Functional Pituitary Adenomas. Fawn M. Wolf, MD 2/2/2018
Functional Pituitary Adenomas Fawn M. Wolf, MD 2/2/2018 Outline Prolactinoma Acromegaly Cushing s disease Thyrotroph adenomas Gonadotroph adenomas Hyperprolactinemia Clinically apparent prolactinomas:
Year 2004 Paper two: Questions supplied by Megan 1
Year 2004 Paper two: Questions supplied by Megan 1 QUESTION 96 A 32yo woman if found to have high blood pressure (180/105mmHg) at an insurance medical examination. She is asymptomatic. Clinical examination
27 F with new onset hypertension and weight gain. Rajesh Jain Endorama 10/01/2015
27 F with new onset hypertension and weight gain Rajesh Jain Endorama 10/01/2015 HPI 27 F with hypertension x 1 year BP 130-140/90 while on amlodipine 5 mg daily She also reports weight gain, 7 LB, mainly
X/97/$03.00/0 Vol. 82, No. 6 Journal of Clinical Endocrinology and Metabolism Copyright 1997 by The Endocrine Society
0021-972X/97/$03.00/0 Vol. 82, No. 6 Journal of Clinical Endocrinology and Metabolism Printed in U.S.A. Copyright 1997 by The Endocrine Society Effectiveness Versus Efficacy: The Limited Value in Clinical
Evaluation and Management of Pituitary Failure. Dr S. Ali Imran MBBS, FRCP (Edin), FRCPC Professor of Medicine Dalhousie University, Halifax, NS
Evaluation and Management of Pituitary Failure Dr S. Ali Imran MBBS, FRCP (Edin), FRCPC Professor of Medicine Dalhousie University, Halifax, NS Conflict of Interest None Objectives Diagnostic approach
ROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU)
ROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU) In 1935, Stein and Leventhal described 7 women with bilateral enlarged PCO, amenorrhea or irregular menses, infertility and masculinizing
Adrenal Disorders for the USMLE, Step One: Abnormalities of the Fasciculata: Hypercortisolism
Adrenal Disorders for the USMLE, Step One: Abnormalities of the Fasciculata: Hypercortisolism Howard Sachs, MD Patients Course, 2017 Associate Professor of Clinical Medicine UMass Medical School Adrenal
KNUH. Cushing s syndrome. Endocrinology & Metabolism KNUH
KNUH Cushing s syndrome Endocrinology & Metabolism KNUH 2006 Harvey William Cushing (1869-1939) Cast of the Hand of Harvey Cushing, 1922 Cushing s syndrome Hypothalamus CRH? Excess of glucocorticoids Disturbance
ABNORMAL PITUITARY FUNCTION
Overview ABNORMAL PITUITARY FUNCTION Specialist Portfolio Seminar Katie Jones Sandwell and West Birmingham Hospitals NHS Trust Anterior pituitary overview Posterior pituitary overview Pituitary dysfunction
Mineralocorticoids: aldosterone Angiotensin II/renin regulation by sympathetic tone; High potassium will stimulate and ACTH Increase in aldosterone
Disease of the Adrenals 1 Zona Glomerulosa Mineralocorticoids: aldosterone Angiotensin II/renin regulation by sympathetic tone; High potassium will stimulate and ACTH Increase in aldosterone leads to salt
Update on Cushing s disease (CD)
Update on Cushing s disease (CD) Beverly MK Biller, MD Professor of Medicine Harvard Medical School Neuroendocrine Clinical Center Massachusetts General Hospital Boston, MA Disclosure of potential relevant
Hyperandrogenism. Dr Jack Biko. MB. BCh (Wits), MMED O & G (Pret), FCOG (SA), Dip Advanced Endoscopic Surgery(Kiel, Germany)
Hyperandrogenism Dr Jack Biko MB. BCh (Wits), MMED O & G (Pret), FCOG (SA), Dip Advanced Endoscopic Surgery(Kiel, Germany) 2012 Hyperandrogenism Excessive production of androgens Adrenal glands main source
Petrosal Sinus Sampling in the Diagnosis of Cushing's Syndrome: Preliminary Experience in University of Malaya Medical Centre
ORIGINAL ARTICLE Petrosal Sinus Sampling in the Diagnosis of Cushing's Syndrome: Preliminary Experience in University of Malaya Medical Centre R Norlisah, FRCR*, BJ J Abdullah, FRCR*, F L Hew, MRCP, S
How to Recognize Adrenal Disease
How to Recognize Adrenal Disease CME Away India & Sri Lanka March 23 - April 7, 2018 Richard A. Bebb MD, ABIM, FRCPC Consultant Endocrinologist Medical Subspecialty Institute Cleveland Clinic Abu Dhabi
Advances in Pituitary. Anne Klibanski, M.D. Massachusetts General Hospital Harvard Medical School
Advances in Pituitary Anne Klibanski, M.D. Massachusetts General Hospital Harvard Medical School Pituitary tumor types Gonadotroph (15-40%) Clinically nonfunctioning Visual field loss Hypopituitarism Thyrotroph
Treatment of Cushing s Syndrome: An Endocrine Society Clinical Practice Guideline
SPECIAL FEATURE Clinical Practice Guideline Treatment of Cushing s Syndrome: An Endocrine Society Clinical Practice Guideline Lynnette K. Nieman (chair), Beverly M. K. Biller, James W. Findling, M. Hassan
Pregnancy and pituitary disorders
European Journal of Endocrinology (2010) 162 453 475 ISSN 0804-4643 REVIEW Pregnancy and pituitary disorders Z Karaca, F Tanriverdi, K Unluhizarci and F Kelestimur Department of Endocrinology, Erciyes
Sharon maslovitz Lis Maternity Hospital
Sharon maslovitz Lis Maternity Hospital Case report Chief complaint 27 yo, with PMC @ 31+3w, BCBA twins Complaints of severe rt parietal and retrobulbar headaches Medical background Healthy until 24yo
Southern Derbyshire Shared Care Pathology Guidelines. Secondary Hypertension
Southern Derbyshire Shared Care Pathology Guidelines Secondary Hypertension Purpose of Guideline This guideline covers the investigation and referral criteria of patients with suspected secondary causes
Checking the Right Box at the Right Age: the Art of Pediatric Endocrine Testing
Checking the Right Box at the Right Age: the Art of Pediatric Endocrine Testing Jean-Pierre Chanoine, MD Endocrinology and Diabetes Unit British Columbia s Children s Hospital Objectives 1. Interpret the
Imaging pituitary gland tumors
November 2005 Imaging pituitary gland tumors Neel Varshney,, Harvard Medical School Year IV Two categories of presenting signs of a pituitary mass Functional tumors present with symptoms due to excess
in Primary Care (Part 2) Jonathan R. Anolik, MD, FACP, FACE Lewis Katz School of Medicine at Temple University
Common Endocrine Problems Seen in Primary Care (Part 2) Lecture #34 Jonathan R. Anolik, MD, FACP, FACE Lewis Katz School of Medicine at Temple University None Conflict of Interest Topics to be Covered
Mechanism of hyperprolactinemia
Hyperprolactinemia Mechanism of hyperprolactinemia Causes of hyperprolactinemia Hormone-producing pituitary tumors Prolactinoma Acromegaly Hypothalamic/pituitary stalk lesion Tumors, cysts (craniopharyngeoma,
Disclosure. Objectives. Understanding The Journey: PCOS, Cushing s Disease, Panhypopituitarism to Endocrine Nurse
Understanding The Journey: PCOS, Cushing s Disease, Panhypopituitarism to Endocrine Nurse May 17, 2018 Bonita Springs, Florida Rebecca Brooke RN, BSN Disclosure I have no actual or potential conflict of
A case of failed bariatric surgery
A case of failed bariatric surgery Gabriel I. Uwaifo, MD, FACP, FACE, FTOS, Department of Endocrinology, diabetes, metabolism and weight management, Ochsner medical center Case Presentation DH is a 35
Medical Therapy: Indications
Medical Therapy: Indications Severe complications of hypercortisolism Pre-treatment before pituitary surgery Post-treatment after unsuccessful surgery Bridging therapy before, during and after pituitary
Cushing Syndrome in Pediatrics
Cushing Syndrome in Pediatrics Constantine A. Stratakis, MD, D (Med) Sci a,b, * KEYWORDS Cushing syndrome Pituitary tumors Cortisol Adrenal cortex Carney complex Adrenocortical hyperplasia Adrenal cancer
The Investigation of suspected paediatric Cushing s Syndrome (hypercortisolaemia)
The Investigation of suspected paediatric Cushing s Syndrome (hypercortisolaemia) Formulated by Ingrid. C.E. Wilkinson, Martin O. Savage, William M. Drake and Helen L. Storr in February 2018. Centre for
Physiology. The Hypothalamic Pituitary Adrenal Axis. Elena A Christofides, MD, FACE
Elena A Christofides, MD, FACE Endocrinology Associates, Inc Endocrinology Research Associates, Inc Physiology 2 The Hypothalamic Adrenal Axis A Complex Set of Feedback Influences* Hypothalamus releases
In memory of Thomas Addison M.D. Son of Joseph and Sarah Addison. Died June 29th 1860 aged 66 years. For 36 years physician to Guy s Hospital London.
In memory of Thomas Addison M.D. Son of Joseph and Sarah Addison. Died June 29th 1860 aged 66 years. For 36 years physician to Guy s Hospital London. Adrenal insufficiency & Sick Day Rules Case history
Secondary amenorrhoea Dr.ASMAA AL SANJARY
Secondary amenorrhoea Dr.ASMAA AL SANJARY The student at the end of this lecture should be able to: Define secondary amenorrhoea. Classify the causes of secondary amenorrhoea. Describe the commonest three
The Investigation of Cushing Syndrome: Essentials in Optimizing Appropriate Diagnosis and Management
The Investigation of Cushing Syndrome: Essentials in Optimizing Appropriate Diagnosis and Management Agata Juszczak, Ashley Grossman From the University of Oxford and Oxford Centre for Diabetes, Endocrinology
ADRENAL GLANDS. G M Kellerman. Hunter Area Pathology Service
ADRENAL GLANDS G M Kellerman Hunter Area Pathology Service ADRENAL FUNCTIONS THE ADRENAL GLANDS ACTUALLY HAVE 4 QUITE SEPARATE FUNCTIONS 1. MINERALOCORTICOID SECRETION BY THE ZONA GLOMERULOSA OF THE CORTEX
Spontaneous remission of acromegaly and Cushing s disease following pituitary apoplexy: Two case reports
CASE REPORT Spontaneous remission of acromegaly and Cushing s disease following pituitary apoplexy: Two case reports S.H.P.P. Roerink 1 *, E.J. van Lindert 2, A.C. van de Ven 1 Departments of 1 Internal
ACUTE SEVERE CUSHING SYNDROME: NOT ALWAYS ECTOPIC ACTH SYNDROME
Case Report ACUTE SEVERE CUSHING SYNDROME: NOT ALWAYS ECTOPIC ACTH SYNDROME Carlos Tavares Bello, MD 1 ; Inês Gil, MD 2 ; Filipa Alves Serra, MD 3 ; João Sequeira Duarte 1 ABSTRACT Objective: Cushing syndrome
Diseases of the Adrenal gland
Diseases of the Adrenal gland Adrenal insufficiency Cushing disease vs syndrome Pheochromocytoma Hyperaldostronism What are the layers of the adrenal gland?? And what does each layer produce?? What are