José Hernán Martínez-Méndez, Madeleine Gutiérrez-Acevedo, Coromoto Palermo-Garofalo, María de Lourdes Miranda-Adorno, Michelle Mangual-García, Alfredo Sánchez-Cruz, Carmen Rivera-Anaya, Paola Mansilla-Letelier, Ivan Laboy-Ortiz
{"title":"垂体亚厘米微腺瘤患者是否需要激素筛查?","authors":"José Hernán Martínez-Méndez, Madeleine Gutiérrez-Acevedo, Coromoto Palermo-Garofalo, María de Lourdes Miranda-Adorno, Michelle Mangual-García, Alfredo Sánchez-Cruz, Carmen Rivera-Anaya, Paola Mansilla-Letelier, Ivan Laboy-Ortiz","doi":"","DOIUrl":null,"url":null,"abstract":"<p><p>A 54-year-old woman came to our endocrinology clinics presenting with upper and lower extremity paresthesia, salt cravings, episodes of hypotension, fatigue and a long term history of depression. Physical exam was unremarkable. Cervical and brain MRI ordered by her neurologist three years ago revealed sella and pituitary normal in size, stable very small 3 mm pituitary incidentaloma and mild disc bulging. Basal pituitary hormonal screening showed low cortisol and ACTH levels. Insulin Tolerance Test and Glucagon Stimulation Test confirmed secondary ACTH deficiency with concomitant GH deficiency. In spite of medical counseling the patient refused glucocorticoid replacement. Due to the non-specific symptoms of this condition it remains a challenge to be diagnosed by clinicians. In conclusion: Our case shows that hormonal deficiencies may occur in small tumors less than 6 mm.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Do We Need Hormonal Screening In Patients With Subcentimeter Pituitary Microadenomas?\",\"authors\":\"José Hernán Martínez-Méndez, Madeleine Gutiérrez-Acevedo, Coromoto Palermo-Garofalo, María de Lourdes Miranda-Adorno, Michelle Mangual-García, Alfredo Sánchez-Cruz, Carmen Rivera-Anaya, Paola Mansilla-Letelier, Ivan Laboy-Ortiz\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>A 54-year-old woman came to our endocrinology clinics presenting with upper and lower extremity paresthesia, salt cravings, episodes of hypotension, fatigue and a long term history of depression. Physical exam was unremarkable. Cervical and brain MRI ordered by her neurologist three years ago revealed sella and pituitary normal in size, stable very small 3 mm pituitary incidentaloma and mild disc bulging. Basal pituitary hormonal screening showed low cortisol and ACTH levels. Insulin Tolerance Test and Glucagon Stimulation Test confirmed secondary ACTH deficiency with concomitant GH deficiency. In spite of medical counseling the patient refused glucocorticoid replacement. Due to the non-specific symptoms of this condition it remains a challenge to be diagnosed by clinicians. In conclusion: Our case shows that hormonal deficiencies may occur in small tumors less than 6 mm.</p>\",\"PeriodicalId\":75610,\"journal\":{\"name\":\"Boletin de la Asociacion Medica de Puerto Rico\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2015-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Boletin de la Asociacion Medica de Puerto Rico\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Boletin de la Asociacion Medica de Puerto Rico","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Do We Need Hormonal Screening In Patients With Subcentimeter Pituitary Microadenomas?
A 54-year-old woman came to our endocrinology clinics presenting with upper and lower extremity paresthesia, salt cravings, episodes of hypotension, fatigue and a long term history of depression. Physical exam was unremarkable. Cervical and brain MRI ordered by her neurologist three years ago revealed sella and pituitary normal in size, stable very small 3 mm pituitary incidentaloma and mild disc bulging. Basal pituitary hormonal screening showed low cortisol and ACTH levels. Insulin Tolerance Test and Glucagon Stimulation Test confirmed secondary ACTH deficiency with concomitant GH deficiency. In spite of medical counseling the patient refused glucocorticoid replacement. Due to the non-specific symptoms of this condition it remains a challenge to be diagnosed by clinicians. In conclusion: Our case shows that hormonal deficiencies may occur in small tumors less than 6 mm.