14 Girl with Cushing s Disease: An Update. Kristen Dillard, MD Endorama October 17, 2013
|
|
|
- Carol Marshall
- 5 years ago
- Views:
Transcription
1 14 Girl with Cushing s Disease: An Update Kristen Dillard, MD Endorama October 17, 2013
2 Initial Presentation Pt initially presented to pediatrician for school physical in fall Pt was found to be obese (BMI 95 th %), have signs of insulin resistance (acanthosis), hirsutism and thyromegaly (no thyroid exam in notes). Fasting labs: Glucose 103 mg/dl, normal CMP otherwise, normal lipid panel, TSH: 0.95 miu/ml, free testosterone: 2.7 pg/ml; thyroid US: 4 mm solid nodule, hypoechoic hypovascular. Sent to endocrine. Mom told she likely has PCOS.
3 Initial Consultation 13 11/12 yr old female presents to peds endo with hirsutism, acanthosis, impaired fasting glucose ROS: Hirsuitism and acanthosis for ~6 mo 1 yr No polyuria no polydipsia or weight loss No headaches, abdominal pain, or visual deficits Deodorant use ~ 4 yr ago. Menarche ~8 months ago, periods irregular Feels like she will not get taller No high blood pressure in the past
4 Initial Consultation Past medical history: Always been overweight, no meds no allergies Family History: Gestational DM (mom) Mid Parental Height: 64 inches Social Hx: no smoking, no alcohol, no illicit drug use, not sexually active
5 Initial Consultation: PE BP 118/84 Pulse 64 Ht 62.7 inches (40 th %) Wt 155 lb 3.2 oz (90 th %) BMI 27.7 (95 th %) Gen: Pleasant, NAD, cooperative HEENT: hair along jawline, upper lip, anicteric sclera, MMM, Nl visual field, no palpable nodules on thyroid, generous thryoid, no lymphadenopathy, + acanthosis along neck CV: Normal Lungs: CTAB Abd: soft obese, + hair in periumbilical region, no striae Neuro: nl reflexes, good strength in upper and lower extremities Pubertal Exam: no cliteromegally, Tanner 5 breast and pubic hair, + hair on areola
6
7
8
9 Tests Ordered (AM labs) CMP: nl except fasting glucose of 101 mg/dl Insulin: 32.4 uiu/ml ( ) Prolactin: 17.5 ng/ml ( ) Estradiol: 19 pg/ml LH: 19 miu/ml FSH: 9.2 miu/ml Free Testosterone: 3.5 pg/ml SHBG: 5.3 nmol/l ( ) ACTH: pg/ml ( ) Cortisol: 24.4 ( ) Androstenedione: 354 ng/dl (50 224) 17 OH Progesterone: 108 ng/dl (20 285) DHEA S: ug/dl( ) TSH: uiu/ml Free T4: 1.26 ng/dl Bone age: ordered but not done
10 Tests Ordered (AM labs) CMP: nl except fasting glucose of 101 mg/dl Insulin: 32.4 uiu/ml ( ) Prolactin: 17.5 ng/ml ( ) Estradiol: 19 pg/ml LH: 19 miu/ml (ratio 2:1) FSH: 9.2 miu/ml Free Testosterone: 3.5 pg/ml SHBG: 5.3 nmol/l ( ) ACTH: pg/ml ( ) Cortisol: 24.4 ( ) Androstenedione: 354 ng/dl (50 224) 17 OH Progesterone: 108 ng/dl (20 285) DHEA S: ug/dl ( ) TSH: uiu/ml Free T4: 1.26 ng/dl Bone age: ordered but not done
11 Additional Evaluation 4 pm: ACTH: 71.8, cortisol: 20.9 Midnight salivary cortisol: insufficient sample X 2 MRI: Ordered High Dose Dex Suppression Test: 8 mg at midnight 8 am cortisol: 1.3 ACTH: 3.6
12 Sellar mass with suprasellar extension and what appears to be indentation at the diaphragmatic sella based on sagittal image seven and demonstrating enhancement, Overall measuring ~10 x 11 x 12 mm, with involvement of the pituitary infundibulum.
13 Next Steps After returning from a month long trip to the Phillipines hypercortisolism was confirmed: 12 am salivary cortisol ug/dl (nl < 0.09) 24 h UFC 80 ug/24h (< 38), urine creatinine 934 mg/24h ( ) Transsphenoidal hemi hypophysectomy performed
14 Post op POD 0 Hydrocortisone 100 mg IV given x 1 before surgery Developed diabetes insipidus vasopressin gtt Resolved by POD 5 Pre Op 14:15 POD 0 23:59 POD 1 02:00 POD 1 08:00 POD 1 14:00 POD 1 21:15 POD 2 02:00 POD 2 08:00 POD 2 14:00 ACTH Cortisol
15 Morning corticotropin (ACTH) after TSS. A, There was a significant decrease in mean plasma ACTH before and after TSS. B, Peak plasma ACTH. C, Plasma ACTH nadir. Batista D L et al. JCEM 2009;94: by Endocrine Society
16 Morning corticotropin (ACTH) after TSS. A, There was a significant decrease in mean plasma ACTH before and after TSS. B, Peak plasma ACTH. C, Plasma ACTH nadir. Batista D L et al. JCEM 2009;94: by Endocrine Society
17 Pathology The frozen section preparations showed relatively uniformly eosinophilic cells that were interpreted at the time as consistent with a pituitary adenoma. The permanent sections, however, show anterior pituitary type tissue with a distinctly small nested arrangement of cells as seen in normal pituitary parenchyma. The tissue is comprised of cells with eosinophilic, basophilic and amphophilic cytoplasm. On the immunohistochemical studies for GH, LH, FSH, TSH, ACTH and prolactin cells expressing different types of pituitary hormones are found intermixed without a clear sheet like proliferation of cells exhibiting restricted pattern of expression. The morphologic studies therefore don't show any changes that would establish a diagnosis of pituitary adenoma. Post operative endocrine studies suggest a normalization of hormone levels. Some of the removed tissue was not submitted for analysis but went into the aspirator. The etiology of the patient's endocrinopathy and the MRI findings of a swollen uniformly enhancing pituitary are not completely explained by these results.
18 Endo Neurosurg Path Meeting Normal pituitary architecture does not explain MRI findings Corticotroph hyperplasia? Not c/w path Residual adenoma in adenohypophysis or infundibulum? Does not explain diffuse pituitary enhancement CRH secreting adenoma? Exceedingly rare May explain clinical picture but produces corticotroph hyperplasia Therapeutic options Bilateral adrenalectomy (risk for Nelson syndrome), radiotherapy/radiosurgery (feasibility) or re exploration (high risk for hypopituitarism) Need more data
19 POD 2 POD 2 POD 2 POD 2 POD 3 POD 3 02:00 08:00 14:00 20:00 02:00 08:00 ACTH Post op course POD 3 14:09 POD 3 23:13 POD 4 11:17 POD 4 23:34 POD 5 07:59 POD 5 23:40 POD 6 08:29 Cortisol days later: salivary and 24 hr urinary Elapsed Time free cortisol (Endo Lab): ACTH Stimulated (Endo Lab) Cortisol, Stimulated (Endo Lab) CRH stimulation MINUS LDDST No hypercortisolism for now Recommended pit screening during next 1 2 months To PMD: Consider 2 nd opinion and/or discussion with NIH
20 Follow up 2 months later, low 12 a salivary cortisol x 2 Afternoon labs ACTH 25 Cortisol 14.6 LH 7.5 FSH 4.9 E Free Te 2.4 Menses have not resumed Acanthosis improved
21 CRH Secreting Adenomas 5 studies from yo M w/ primary lung metastatic small cell carcinoma and central DI (Carey et al NEJM 1984) Crook s hyalin changes CRH like peptide was found to be secreted by carcinoma
Stelios Mantis, MD DuPage Medical Group Pediatric Endocrinology
Stelios Mantis, MD DuPage Medical Group Pediatric Endocrinology 4 11 13 Initial Presentation Pt initially presented to pediatrician for school physical in fall 2012. Pt was found to be overweight (BMI:
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
Kristen Dillard, M.D. Endorama December 6, 2012
Kristen Dillard, M.D. Endorama December 6, 2012 12 7/12 yo girl with h/o Cushing s disease presented to OSH with concern for CVA Consumed ½plate of food the night before, had raisins and diet soda on the
13 y.o male with delayed puberty, and XX chromosomes. Stelios Mantis, MD
13 y.o male with delayed puberty, and XX chromosomes Stelios Mantis, MD 4-5-12 Initial Clinic Visit CC: 13 2/12 y.o male with a concern for delayed puberty and growth problems. HPI: Complicated past med
More than meets the eye
More than meets the eye Ana Paula Abreu, MD, PhD American Association of Clinical Endocrinologists New England Chapter Annual Meeting September 8, 2018 Disclosures No conflict of interest or significant
62-year-old woman with severe headache. Celeste Thomas November 1, 2012
62-year-old woman with severe headache Celeste Thomas November 1, 2012 History of Present Illness History of hypertension and hyperlipidemia Presented to outside hospital after awakening from sleep with
16 YEAR-OLD OBESE FEMALE WITH OLIGOMENORRHEA
16 YEAR-OLD OBESE FEMALE WITH OLIGOMENORRHEA Katie O Sullivan, MD Adult/Pediatric Endocrinology Fellow University of Chicago ENDORAMA Thursday, September 4th, 2014 Disclosures No financial interests. Will
Overview of Reproductive Endocrinology
Overview of Reproductive Endocrinology I have no conflicts of interest to report. Maria Yialamas, MD Female Hypothalamic--Gonadal Axis 15 4 Hormone Secretion in the Normal Menstrual Cycle LH FSH E2, Progesterone,
Case Questions. Polycystic Ovarian Syndrome: Treatment Goals and Options. Differential Diagnosis of Hyperandrogenic Anovulation
Polycystic Ovarian Syndrome: Treatment Goals and Options Marc Cornier, MD Division of Endocrinology, Metabolism and Diabetes Colorado Center for Health and Wellness University of Colorado School of Medicine
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
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
Pituitary Stalk Interruption Syndrome. Leena Shahla, MD, PGY5 Endocrinology, Diabetes and Metabolism Fellowship University of Massachusetts
Pituitary Stalk Interruption Syndrome Leena Shahla, MD, PGY5 Endocrinology, Diabetes and Metabolism Fellowship University of Massachusetts 11/12/2016 Case: NP, 42 year old female, from Dominican Republic.
12/27/2013. Kristen Cain, MD FACOG Reproductive Medicine Institute Sanford Health, Fargo ND
Kristen Cain, MD FACOG Reproductive Medicine Institute Sanford Health, Fargo ND 7% of all women 18-45 Obesity 1/3 of all US women Incidence of PCOS is increasing with increase obesity Obesity Irregular
3- & 12-Year-Old Sisters with Li-Fraumeni Syndrome KRISTEN DILLARD, M.D. ENDORAMA FEBRUARY 28, 2013
3- & 12-Year-Old Sisters with Li-Fraumeni Syndrome KRISTEN DILLARD, M.D. ENDORAMA FEBRUARY 28, 2013 Presentation Sisters referred by Peds Oncology to Endo clinic for adrenocortical carcinoma screening
53 year old Female with Hypoglycemia. Colleen Flynn, MD April 5, 2012
53 year old Female with Hypoglycemia Colleen Flynn, MD April 5, 2012 HPI 53 yo F referred to the endocrine clinic for hypoglycemia x 1 year. History of a non secreting metastatic neuroendocrine tumor diagnosed
5yo girl with vaginal bleeding. Matthew Wise, MD Med Peds Endo January 26, 2012
5yo girl with vaginal bleeding Matthew Wise, MD Med Peds Endo January 26, 2012 HPI 5y 10m Caucasian girl 2mo prior: labial swelling 1mo prior: painless vaginal bleeding x5days, pads q4 6h breast buds noted
15 month-old female with a cystic brain lesion. Magdalena Dumin, MD Pediatric Endocrinology Fellow University of Chicago December 4, 2014
+ 15 month-old female with a cystic brain lesion Magdalena Dumin, MD Pediatric Endocrinology Fellow University of Chicago December 4, 2014 + Chief Complaint 15 month-old female admitted to PICU for concern
3 year old boy with puberty. Katie Stanley, MD August 1, 2013
3 year old boy with puberty Katie Stanley, MD August 1, 2013 Initial presentation 3 and 11/12 year old boy with signs of puberty Presented to outside endocrinologist in 2002 with: Pubic hair since 2.5
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
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,
10 yo boy w/chiari/pseudotumor seen for obesity. 8/22/13 Jess Hwang
10 yo boy w/chiari/pseudotumor seen for obesity 8/22/13 Jess Hwang HPI Kids at school have been teasing him about his weight and the skin darkening around his neck 127lb was peak weight Quit desserts/soda
26 YEAR-OLD FEMALE WITH HEADACHES AND OLIGOMENORRHEA
26 YEAR-OLD FEMALE WITH HEADACHES AND OLIGOMENORRHEA Katie O Sullivan, M.D. Adult/Pediatric Endocrinology Fellow University of Chicago Combined Pituitary Conference Thursday, September 11 th, 2014 History
Case. 24 year old female presented to your office complaining of excess hair growth on her face and abdomen. Questions?
Hirsutism Case 24 year old female presented to your office complaining of excess hair growth on her face and abdomen Questions? Started around puberty with gradual progression Irregular menstrual cycle
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
Endocrinological Outcome Among Treated Craniopharyngioma Patients
Endocrinological Outcome Among Treated Craniopharyngioma Patients Afaf Al Sagheir, MD Head & Consultant, Section of Endocrinology/Diabetes Department of Pediatrics KFSH&RC Introduction Craniopharyngiomas
33-Year-Old Female With Amenorrhea DISHA KUMAR NARANG, MD PITUITARY ENDORAMA DECEMBER 11, 2014
33-Year-Old Female With Amenorrhea DISHA KUMAR NARANG, MD PITUITARY ENDORAMA DECEMBER 11, 2014 Our Patient 33-year-old female presents to endocrinology clinic after amenorrhea for 4 years History of Present
51 year old woman with hyperglycemia. August 9, 2012 Katie Stanley, MD
51 year old woman with hyperglycemia August 9, 2012 Katie Stanley, MD HPI Diagnosed with DM 1 year prior to visit Established primary care at that time due to notable weight loss after tobacco cessation
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
66 M with erectile dysfunction and abnormal labs RAJESH JAIN ENDORAMA 10/29/2015
66 M with erectile dysfunction and abnormal labs RAJESH JAIN ENDORAMA 10/29/2015 HPI 66 M presenting as a referral for erectile dysfunction and abnormal labs Has been seeing a facility specializing in
What we will cover. Evaluation of the Child with Suspected Pituitary Disease. ituitary
Evaluation of the Child with Suspected Pituitary Disease Craig Alter, MD University of Pennsylvania Children s Hospital of Philadelphia What we will cover * What laboratory tests to order * MRI: common
Dr Stella Milsom. Endocrinologist Fertility Associates Auckland. 12:30-12:40 When Puberty is PCO
Dr Stella Milsom Endocrinologist Fertility Associates Auckland 12:30-12:40 When Puberty is PCO Puberty or Polycystic Ovary Syndrome? Stella Milsom Endocrinologist Auckland DHB, University of Auckland,
33 year old male with a history of resected craniopharyngioma (12 years ago) presents after a seizure. Jess Hwang 9/27/12
33 year old male with a history of resected craniopharyngioma (12 years ago) presents after a seizure Jess Hwang 9/27/12 Craniopharyngioma history In 2000, at age 22, he presented with headache and blurry
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
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
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
Polycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018
Polycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018 Learning Objectives At the conclusion of this lecture, learners should: 1) Know the various diagnostic
Polycystic Ovary Syndrome
Polycystic Ovary Syndrome Kathleen Colleran, MD Professor of Medicine University of New Mexico HSC Presented for COMM-TC May 4, 2012 Objectives Understand the pathophysiology of PCOS Understand how to
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
Diseases of pituitary gland
Diseases of pituitary gland A brief introduction Anterior lobe = adenohypophysis Posterior lobe = neurohypophysis The production of most pituitary hormones is controlled in large part by positively and
43 year old man with low libido. Katie Stanley, MD August 16, 2012
43 year old man with low libido Katie Stanley, MD August 16, 2012 HPI 43 yo M with history of heroin addiction on methadone maintenance Reported low libido to PCP PCP checked testosterone and found to
47 Year-Old Female with Headache. Olesya Krivospitskaya, MD Second year endocrinology fellow
47 Year-Old Female with Headache Olesya Krivospitskaya, MD Second year endocrinology fellow HPI: 47 y.o. female presented to ER with c/o acute onset of headache at the vertex of her head and retro-orbital
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.
Hypothalamus & Pituitary Gland
Hypothalamus & Pituitary Gland Hypothalamus and Pituitary Gland The hypothalamus and pituitary gland form a unit that exerts control over the function of several endocrine glands (thyroid, adrenals, and
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
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.
Blood Pressure Measurement (children> 3 yrs)
Blood Pressure Measurement (children> 3 yrs) If initial BP elevated, repeat BP manually 2x and average, then classify Normal BP Systolic and diastolic
Disclosure. Session Objectives. I have no actual or potential conflict of interest in relation to this program/presentation.
46, XY Female: A Case of Complete Androgen Insensitivity Syndrome (CAIS) MICHELLE MCLOUGHLINMSN, CRNP, CPNP-AC THE CHILDREN S HOSPITAL OF PHILADELPHIA DIVISION OF ENDOCRINOLOGY AND DIABETES Disclosure
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
8-year-old male with premature adrenarche. Endorama June 14, 2012 Rochelle Naylor, MD
8-year-old male with premature adrenarche Endorama June 14, 2012 Rochelle Naylor, MD CC CC: Transfer of endocrinology care for premature adrenarche and bone age advancement at 8 yr old Initial presentation
2-year-old girl with premature thelarche. Endorama February 5, 2015 Carmen Mironovici, M.D.
2-year-old girl with premature thelarche Endorama February 5, 2015 Carmen Mironovici, M.D. Chief complaint Premature thelarche first noted at 21 months of age Patient referred to Endocrinology Clinic for
Pathology of pituitary gland. By: Shifaa Qa qa
Pathology of pituitary gland By: Shifaa Qa qa Sella turcica Adenohypophysis (80%): - epithelial cells - acidophil, basophil, chromophobe - Somatotrophs, Mammosomatotrophs, Corticotrophs, Thyrotrophs, Gonadotrophs
Reproductive Health and Pituitary Disease
Reproductive Health and Pituitary Disease Janet F. McLaren, MD Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology jmclaren@uabmc.edu Objectives
UW MEDICINE PATIENT EDUCATION. Acromegaly Symptoms and treatments. What is acromegaly? DRAFT. What are the symptoms? How is it diagnosed?
UW MEDICINE PATIENT EDUCATION Acromegaly Symptoms and treatments This handout explains a health condition called acromegaly. It describes tests that are used to diagnose the condition and gives basic instructions
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
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
Case Report A Rare Corticotroph-Secreting Tumor with Coexisting Prolactin and Growth Hormone Staining Cells
Case Reports in Endocrinology Volume 2012, Article ID 529730, 5 pages doi:10.1155/2012/529730 Case Report A Rare Corticotroph-Secreting Tumor with Coexisting Prolactin and Growth Hormone Staining Cells
Treating Cystic Prolactinomas with Dopamine Agonists: Partial Cabergoline Resistance and Considering Dose Reduction
Treating Cystic Prolactinomas with Dopamine Agonists: Partial Cabergoline Resistance and Considering Dose Reduction Mohammad Talha Rauf, MD Internal Medicine Resident PGY3 Dania AbuShanab, MD Julie Samantray,
57-year-old man with anxiety, diaphoresis, fatigue and bilateral adrenal nodules. Celeste Thomas November 1, 2012
57-year-old man with anxiety, diaphoresis, fatigue and bilateral adrenal nodules Celeste Thomas November 1, 2012 History of Present Illness 8 months prior to presentation developed intermittent right flank
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
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
JACK L. SNITZER, DO INTERNAL MEDICINE BOARD REVIEW COURSE 2018 PITUITARY
JACK L. SNITZER, DO INTERNAL MEDICINE BOARD REVIEW COURSE 2018 PITUITARY JACK L. SNITZER, D.O. Peninsula Regional Endocrinology 1415 S. Division Street Salisbury, MD 21804 Phone:410-572-8848 Fax:410-572-6890
PROCESSING INSTRUCTIONS FOR BRAC TESTS. PROCESSING SPECIFICATIONS Storage 5. Centrifuge Temp ( C) 10 mins. Alternate Draw Tube.
Preferred Amount of Blood (ml) Amount of Blood (ml) PROCESSING INSTRUCTIONS FOR BRAC TESTS Preferred Draw PROCESSING SPECIFICATIONS Storage 5 Alternate Draw Centrifuge 10 mins Preferred Aliquot (ml) Aliquot
RECURRENT ADRENAL DISEASE. Megan Applewhite Endorama 2/19/2015 SR , SC
RECURRENT ADRENAL DISEASE Megan Applewhite Endorama 2/19/2015 SR 2412318, SC 3421561 Category: Adrenal Attendings: Angelos & Grogan PATIENT #1 36yo woman with a hx of Cushing s Syndrome and right adrenalectomy
Idiopathic central precocious puberty associated with an enlarged pituitary gland
Idiopathic central precocious puberty associated with an enlarged pituitary gland Idiopathic central precocious puberty associated with an enlarged pituitary gland S Pathmanathan 1, Navoda Atapattu 2,
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
Polycystic Ovarian Syndrome. Heidi Hallonquist, MD Concord Hospital Concord Obstetrics and Gynecology
Polycystic Ovarian Syndrome Heidi Hallonquist, MD Concord Hospital Concord Obstetrics and Gynecology Outline Definition Symptoms Causal factors Diagnosis Complications Treatment Why are we talking about
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
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
2.0 Synopsis. Lupron Depot M Clinical Study Report R&D/09/093. (For National Authority Use Only) to Part of Dossier: Name of Study Drug:
2.0 Synopsis Abbott Laboratories Individual Study Table Referring to Part of Dossier: Name of Study Drug: Volume: Abbott-43818 (ABT-818) leuprolide acetate for depot suspension (Lupron Depot ) Name of
Adrenal Stress Profile (Saliva)
Adrenal Stress Profile (Saliva) Ireland Cortisol Levels Sample 1 Post Awakening Sample 2 (+ 4-5 Hours) Sample 3 (+ 4-5 Hours) Sample 4 (Prior to Sleep) 11.42 2.10 1.60 0.47 Sum of Cortisol 15.590 DHEA
Mechanism of hyperprolactinemia
Hyperprolactinemia Mechanism of hyperprolactinemia Causes of hyperprolactinemia Hormone-producing pituitary tumors Prolactinoma Acromegaly Hypothalamic/pituitary stalk lesion Tumors, cysts (craniopharyngeoma,
Initials:.. Number of patient in the registry:... Date of visit:.. Gender (genetic): female / male
1. Patient personal details Institute code: Physician code: Initials:.. Number of patient in the registry:... Date of visit:.. Gender (genetic): female / male 2. Changes in acromegaly-specific medical
ENDOCRINOLOGY COORDINATION OF PHYSIOLOGICAL PROCESSES:
ENDOCRINOLOGY COORDINATION OF PHYSIOLOGICAL PROCESSES: -In a living organism there must be coordination of number of physiological activities taking place simultaneously such as: movement, respiration,
Abnormal Uterine Bleeding Case Studies
Case Study 1 Abnormal Uterine Bleeding Case Studies Abigail, a 24 year old female, presents to your office complaining that her menstrual cycles have become a problem. They are now lasting 6 7 days instead
TEST REPORT # SB. Patient Name: Comprehensive Male Profile I Patient Phone Number: TEST NAME RESULTS 08/12/18 RANGE
TEST REPORT Ordering Provider: David Getuwell, MD 8605 SW Creekside Place Beaverton, OR 97008 Phone: 503-466-2445 Fax: 503-466-1636 Samples Received 08/15/2018 Report Date 08/20/2018 Samples Collected
Endocrine system overview
Endocrine system overview Nature of the hormonal system -Major integrator of body function Classification of hormones Endocrine vs paracrine Nature of hormone-receptor systems Role of the hypothalamuspituitary
Peri-op Pituitary / Diabetes Insipidus/ Apoplexy Dr. Stan Van Uum, MD, PhD, FRCPC
10 th Annual Canadian Endocrine Update 3 rd Canadian Endocrine Review Course Peri-op Pituitary / Diabetes Insipidus/ Apoplexy Dr. Stan Van Uum, MD, PhD, FRCPC 10 th Annual Canadian Endocrine Update Dr.
Suzanne Hecht, MD, FACSM, CCD Associate Professor UM Sports Medicine Team Physician; UM Athletics Program Director; UM Sports Med Fellowship
Suzanne Hecht, MD, FACSM, CCD Associate Professor UM Sports Medicine Team Physician; UM Athletics Program Director; UM Sports Med Fellowship Primary Care Sports Medicine Advisory Board for DonJoy Orthopedics
Pituitary Disorders. Eiman Ali Basheir Mob: /1/2019
Pituitary Disorders Eiman Ali Basheir Mob: 0915020385 31/1/2019 Objectives By the end of this lecture the students will be able to: Understand basic Pituitary axis physiology State the common causes of
lactotrophs 120 min- FSH 60 min- LH Hypothalamus GnRH pituitary Estradiol +/- Progesterone _ FSH L H Ovary Uterus Ovulation Antral follicle >2mm
lactotrophs Hypothalamus GnRH 120 min- 60 min- LH Progesterone _ pituitary L H + Ovary + Estradiol +/- Uterus Antral follicle >2mm Ovulation Preovulatory follicles atresia Follicular phase Luteal phase
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
Kingdom of Bahrain Arabian Gulf University College of Medicine and Medical Sciences. Endocrinology. (Review) Year 5 Internal Medicine
Kingdom of Bahrain Arabian Gulf University College of Medicine and Medical Sciences Endocrinology (Review) Year 5 Internal Medicine Presented by: Dr. Mona Arekat Prepared by: Ali Jassim Alhashli Case (1):
John Sutton, DO, FACOI, FACE, CCD. Carson Tahoe Endocrinology Carson City, NV KCOM Class of 1989
John Sutton, DO, FACOI, FACE, CCD Carson Tahoe Endocrinology Carson City, NV KCOM Class of 1989 Gonadal Physiology and Disease 3 No Disclosures Gonadal Axis Hypothalamic-pituitary-gonadal Feedback mechanisms
Pseudo-Endocrine Disorders Practical Management Strategies
Pseudo-Endocrine Disorders Practical Management Strategies 2018 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Pseudo-Endocrine
Pseudo-Endocrine Disorders Practical Management Strategies
Pseudo-Endocrine Disorders Practical Management Strategies 2018 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Internet
12/13/2017. Important references for PCOS. Polycystic Ovarian Syndrome (PCOS) for the Family Physician. 35 year old obese woman
Polycystic Ovarian Syndrome (PCOS) for the Family Physician Barbara S. Apgar MD, MS Professor or Family Medicine University of Michigan Ann Arbor, Michigan Important references for PCOS Endocrine Society
MULTI-SYSTEM SARCOIDOSIS CAUSING PANHYPOPITUITARISM: RAPID IMPROVEMENT WITH CORTICOSTEROID THERAPY Rashid Mahboob, MD; Ali A.
ENDOCRINE PRACTICE Rapid Electronic Article in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been reviewed and accepted for publication, but have yet to be edited, typeset
Endocrine Glands: Hormone-secreting organs are called endocrine glands
University of Jordan Department of Physiology and Biochemistry Nursing students, Academic year 2017/2018. ******************************************************************* Ref: Principles of Anatomy
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
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
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
PCOS Awareness Symposium Atlanta September 24 th, Preventing Diabetes & Cardiovascular Disease in PCOS
PCOS Awareness Symposium Atlanta September 24 th, 2016 Preventing Diabetes & Cardiovascular Disease in PCOS Katherine Sherif, MD Professor & Vice Chair, Department of Medicine Director, Jefferson Women
A short & obese - girl
A short & obese - girl Presented by :Dr.Amit P Ghawade (DNB Resident-1st Year ) Guide :Dr.S.Ramkumar MD(pediatrics) ICH & HC, Chennai, DM(endocrinology) AIIMS, Delhi Department of Pediatric Endocrinology
Rhythm Plus- Comprehensive Female Hormone Profile
Rhythm Plus- Comprehensive Female Hormone Profile Patient: SAMPLE REPORT DOB: Sex: F Order Number: K00000 Completed: Received: Collected: SAMPLE REPORT Sample # Progesterone (pg/ml) Hormone Results Oestradiol
Puberty and Pubertal Disorders. Lisa Swartz Topor, MD, MMSc Pediatric Endocrinology July 2018
Puberty and Pubertal Disorders Lisa Swartz Topor, MD, MMSc Pediatric Endocrinology July 2018 Objectives Review normal pubertal development Recognize common pubertal disorders Identify recent trends in
CYSTIC PROLACTINOMA: A SURGICAL DISEASE?
AACE Clinical Case Reports Rapid Electronic Articles in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been reviewed and accepted for publication, but have yet to be edited,
Testosterone Therapy in Men with Hypogonadism
Testosterone Therapy in Men with Hypogonadism (Endocrine Society 2018 Guideline) Ngwe Yin, MD Assistant Clinical Professor of Medicine, UCSF Fresno Medical Education Program Disclosures None Objective
Polycystic Ovarian Syndrome (PCOS) LOGO
Polycystic Ovarian Syndrome (PCOS) Ma qianhong Ob/Gyn Department LOGO Contents Epidemiology and Definition Pathophysiology, Endocrinological Features Diagnostic Criteria Treatment Prognosis Introduction
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