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1 [[Skull Base Surgery Atlas (stanford.edu)>>url:https://skullbasesurgeryatlas.stanford.edu/]]
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4 How is pituitary carcinoma diagnosed in 2023?
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6 * Purely clinically. It is not a histological diagnosis. It is diagnosed based on the presence of distal recurrences in the brain (eg posterior fossa) or spine.
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8 After prolactinoma resection the prolactin level decreases substantially but remains elevated 24 hours after surgery. What does this say about likely extent of resection?
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10 * There is likely some residual. The half life of prolactin is very short and you would expect to see the level normalize quickly postop if you got a GTR
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12 = Cushing Disease =
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14 Causes of hypercortisolism:
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16 1. Iatrogenic is the most common
17 1. Endogenous
18 11. Central, i.e. from the pituitary, 70% of the time
19 11. Peripheral, i.e. from the adrenal gland, 29% of the time
20 11. Paraneoplastic, 1% of the time. This is associated with very high ACTH levels
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22 Symptoms:
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24 1. Weight gain
25 1. Abdominal striae
26 1. Easy brusing
27 1. Buffalo hump
28 1. Moon facies
29 1. Hypertension
30 1. Hirsutism
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32 Mimics of Cushing:
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34 * PCOS
35 * Alcoholism causes an elevated ACTH level and central adiposity
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37 Diagnosis of Cushing disease:
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39 1. Low dose dexamethasone suppression test
40 1. 24-hour urinary cortisol
41 1. Late night salivary cortisol x2
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43 Dexamethasone suppression testing:
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45 * Low dose is used to diagnose Cushing disease.
46 ** Dexamethasone level is used to verify that the patient did, in fact, take the dexamethasone
47 ** If the AM cortisol is low, this is appropriate suppression and is what is seen in a normal individual
48 ** If the AM cortisol is high, the patient has Cushing disease
49 * High dose is to distinguish central from peripheral causes
50 ** If the AM cortisol is low, the diagnosis is central Cushing
51 ** If the AM cortisol is high, the diagnosis is peripheral Cushing
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