case_images: PMC3833195_01
case_images: PMC3833195_02
case_images: Preoperative MRI.
case_images: CRIM.ENDOCRINOLOGY2013-735489.001.jpg
case_images: PMC3833195_02_CRIM.ENDOCRINOLOGY2013-735489.001.jpg
case_images: fig1
case_images: A cavernous sinus sampling of ACTH levels after corticotrophin-releasing hormone (CRH) stimulation was elevated to 3650 pg/mL on the right side of the pituitary at 3 minutes and elevated to 12,368 pg/mL on the left at 5 minutes poststimulation. (A ratio central to periphery > 3 is suggestive of a pituitary source of ACTH.) Magnetic resonance imaging (MRI; Figure 1) demonstrated a 7-8 mm tumor in the superior aspect of the pituitary anterior to the infundibulum, located slightly left of midline.
case_images: Postoperative MRI at 2 years follow-up.
case_images: CRIM.ENDOCRINOLOGY2013-735489.002.jpg
case_images: PMC3833195_02_CRIM.ENDOCRINOLOGY2013-735489.002.jpg
case_images: fig2
case_images: ACTH levels remained normal for more than a year after the second surgery, but after 2 years, UFC was 73.6 mug/24 hr. A 27-month postsurgical MRI showed a 2 mm lesion to the right of midline (Figure 2).
case_images: UFC and weight over time.
case_images: CRIM.ENDOCRINOLOGY2013-735489.003.jpg
case_images: PMC3833195_02_CRIM.ENDOCRINOLOGY2013-735489.003.jpg
case_images: fig3
case_images: Biochemical tests normalized during the core study (9-month UFC, 31 mug/24 h; morning ACTH, 33 ng/L; serum cortisol, 19 mug/dL), after which the patient lost 17 kg of body weight (Figure 3).
case_images: HbA1c variations over time.
case_images: CRIM.ENDOCRINOLOGY2013-735489.004.jpg
case_images: PMC3833195_02_CRIM.ENDOCRINOLOGY2013-735489.004.jpg
case_images: fig4
case_images: The patient's HbA1c level persisted below 7.0% (Figure 4).