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A 52-year-old female with a hoarse voice and tingling in the hand.

Razvi S, Perros P - PLoS Med. (2007)

View Article: PubMed Central - PubMed

Affiliation: Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom. salmanrazvi@hotmail.com

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A magnetic resonance imaging (MRI) scan had shown a small “cyst” in the pituitary gland... The above scenario is increasingly common as a result of the advent of powerful imaging techniques such as MRI and computerised tomography scanning, which identify “coincidental” pituitary abnormalities in a significant minority of the adult population... The history, in this patient, is typical of CTS and is characterised by pain, tingling, and numbness in the median nerve distribution... This patient does not have hypothyroidism (normal thyroid hormone and serum TSH levels) or diabetes mellitus (although she has impaired fasting glycaemia), was not pregnant or obese, and did not have a history or clinical manifestations of rheumatoid arthritis... Therefore, appropriate clinical evaluation should precede biochemical investigations, which then may need to be confirmed by imaging techniques... The pathologic effects of increased GH levels are progressive and are associated with increased morbidity and mortality... Many of the soft tissue overgrowth features as well as the increased cardiovascular risk can be reversed, at least partly for soft tissue and completely for cardiovascular disease, by appropriate therapy... Appropriate therapy may also reduce or even prevent mass effects caused by tumour growth in the pituitary area... Nadir GH levels were 8.6 mu/l with a slightly raised IGF 1 level of 51 nmol/l, signifying partial resolution of acromegaly... Repeat MRI scan showed no definite target for further surgical intervention... This reduced mean GH levels to 2.9 mu/l and normalised IGF 1 levels to 32 nmol/l... The increasing use of imaging techniques has invented a new disorder—the incidentaloma... When incidentalomas are found in the pituitary, a thorough history and examination is required with relevant biochemical tests... The biochemical diagnostic criteria for acromegaly have changed over the past decade, bringing the GH diagnostic threshold to lower levels... The advent of better and more sensitive GH assays and better imaging have helped to diagnose more subtle forms of the disease, which would not have been picked up earlier, and may therefore hopefully reduce morbidity and mortality.

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MRI Studies of the Patient's Pituitary GlandMRI of the pituitary gland showing a non-enhancing lesion occupying the bulk of the pituitary fossa (yellow arrow). The remaining normal pituitary is pushed to the left, as is the pituitary stalk. The optic chiasm can be seen just superior to the pituitary gland (white arrow).
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pmed-0040029-g002: MRI Studies of the Patient's Pituitary GlandMRI of the pituitary gland showing a non-enhancing lesion occupying the bulk of the pituitary fossa (yellow arrow). The remaining normal pituitary is pushed to the left, as is the pituitary stalk. The optic chiasm can be seen just superior to the pituitary gland (white arrow).

Mentions: The OGTT confirms failure of GH to suppress to levels below 2 mu/l (<1 mcg/l) as well as impaired fasting glycaemia and impaired glucose tolerance. Other tests of anterior pituitary function (prolactin, thyroid function tests, luteinising hormone, and follicle-stimulating hormone) as well as dynamic testing of adrenal reserve in response to synthetic ACTH (short synacthen test) were normal. MRI studies of the pituitary gland revealed a pituitary micro-adenoma (Figure 2).


A 52-year-old female with a hoarse voice and tingling in the hand.

Razvi S, Perros P - PLoS Med. (2007)

MRI Studies of the Patient's Pituitary GlandMRI of the pituitary gland showing a non-enhancing lesion occupying the bulk of the pituitary fossa (yellow arrow). The remaining normal pituitary is pushed to the left, as is the pituitary stalk. The optic chiasm can be seen just superior to the pituitary gland (white arrow).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC1808067&req=5

pmed-0040029-g002: MRI Studies of the Patient's Pituitary GlandMRI of the pituitary gland showing a non-enhancing lesion occupying the bulk of the pituitary fossa (yellow arrow). The remaining normal pituitary is pushed to the left, as is the pituitary stalk. The optic chiasm can be seen just superior to the pituitary gland (white arrow).
Mentions: The OGTT confirms failure of GH to suppress to levels below 2 mu/l (<1 mcg/l) as well as impaired fasting glycaemia and impaired glucose tolerance. Other tests of anterior pituitary function (prolactin, thyroid function tests, luteinising hormone, and follicle-stimulating hormone) as well as dynamic testing of adrenal reserve in response to synthetic ACTH (short synacthen test) were normal. MRI studies of the pituitary gland revealed a pituitary micro-adenoma (Figure 2).

View Article: PubMed Central - PubMed

Affiliation: Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom. salmanrazvi@hotmail.com

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A magnetic resonance imaging (MRI) scan had shown a small “cyst” in the pituitary gland... The above scenario is increasingly common as a result of the advent of powerful imaging techniques such as MRI and computerised tomography scanning, which identify “coincidental” pituitary abnormalities in a significant minority of the adult population... The history, in this patient, is typical of CTS and is characterised by pain, tingling, and numbness in the median nerve distribution... This patient does not have hypothyroidism (normal thyroid hormone and serum TSH levels) or diabetes mellitus (although she has impaired fasting glycaemia), was not pregnant or obese, and did not have a history or clinical manifestations of rheumatoid arthritis... Therefore, appropriate clinical evaluation should precede biochemical investigations, which then may need to be confirmed by imaging techniques... The pathologic effects of increased GH levels are progressive and are associated with increased morbidity and mortality... Many of the soft tissue overgrowth features as well as the increased cardiovascular risk can be reversed, at least partly for soft tissue and completely for cardiovascular disease, by appropriate therapy... Appropriate therapy may also reduce or even prevent mass effects caused by tumour growth in the pituitary area... Nadir GH levels were 8.6 mu/l with a slightly raised IGF 1 level of 51 nmol/l, signifying partial resolution of acromegaly... Repeat MRI scan showed no definite target for further surgical intervention... This reduced mean GH levels to 2.9 mu/l and normalised IGF 1 levels to 32 nmol/l... The increasing use of imaging techniques has invented a new disorder—the incidentaloma... When incidentalomas are found in the pituitary, a thorough history and examination is required with relevant biochemical tests... The biochemical diagnostic criteria for acromegaly have changed over the past decade, bringing the GH diagnostic threshold to lower levels... The advent of better and more sensitive GH assays and better imaging have helped to diagnose more subtle forms of the disease, which would not have been picked up earlier, and may therefore hopefully reduce morbidity and mortality.

Show MeSH
Related in: MedlinePlus