Disregard subtle clinical signs at your peril
Dr.Arun 11 Nov 2019
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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