Disregard subtle clinical signs at your peril

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22 year old graduate, noticed stretch marks over her abdomen few months before presentation but was otherwise totally asymptomatic. Over the next few months, she noticed 2 kg weight gain. BP and blood glucose were normal. She had no Cushingoid features but had hyperpigmentation of knuckles. A dexamethasone suppression test was borderline abnormal. Further tests confirmed mild cortisol excess and a pituitary microadenoma on MRI. Although we initially thought a wait and watch approach is better, she continued to gain weight and was keen to undergo TNTS. Postoperatively she is in remission.

High index of suspicion and a low threshold for investigating is the key when faced with telltale clinical signs

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Tags: Endocrinology