Not long ago, I volunteered at an aid station at a local 100-mile ultramarathon. It was a hot day. Many of the runners requested extra salt as they stopped to eat and drink at our aid station; potato chips, boiled potatoes rolled in salt and electrolyte caps were popular items.
The patient mentioned in a previous post came to see me for follow up as an outpatient. To review, he initially presented as an inpatient with hyponatremia due to central adrenal insufficiency. An MRI revealed a 2.2-cm pituitary macroadenoma. His serum sodium normalized on oral hydrocortisone replacement therapy. Laboratory evaluation confirmed panhypopituitarism. We spent most of our visit discussing hormone replacement therapy.
A young woman returned to see me for follow-up regarding obesity and difficulty losing weight.
One of my patients — a young woman in her 20s — previously had adrenal cancer, but has been doing extremely well without evidence of persistent disease. Her initial tumor co-secreted both cortisol and adrenal androgens. Symptoms of hypercortisolism have resolved after surgery last year. Follow-up 24-hour urine-free cortisols have been low-normal, testosterone levels low-normal and dehydroepiandrosterone sulphate (DHEAS) undetectable.
As I had mentioned in previous posts, earlier this summer I had two patients who were diagnosed in the same month with adrenocortical carcinoma. Both are young women who presented with Cushings disease, adrenal androgen production and a large adrenal mass. They underwent surgical resection and have felt much better since.
A colleague asked me about a case of suspected recurrent pheochromocytoma. The patient is already on doxazosin and propranolol. The question we had: Would these medications affect results of biochemical testing?
Recently a colleague asked me about a patient she had with recurrent pheochromocytoma. I wondered about his family history and whether genetic testing would be appropriate.
The next patient I saw that same afternoon was a 22-year-old woman sent to me to rule out possible Cushings.
Yesterday, my first patient in the afternoon was a 27-year-old woman with weight gain and fatigue. She had primary hypothyroidism, but her thyroid-stimulating hormone was 1.57, and free thyroxine and free triiodothyronine were in the mid-normal range. Her primary care physician told her she did not think her symptoms were related to her thyroid but requested she see me anyway. Her physician was concerned there may be something else going on that was being missed.
Previously, I posted about a young woman who presented with rapid onset Cushings syndrome and a 9.0-cm adrenal mass. Her initial 24-hour urine-free cortisol was 1,095 mcg/24 hours (upper limits of normal, 45), one of the highest I have ever seen. She subsequently had surgical resection which confirmed moderately differentiated adrenocortical carcinoma as we had suspected. Fortunately, there was no evidence of extension beyond the adrenal gland or metastatic lymph nodes. Based on size, lack of extension outside the adrenal gland and no known metastasis, she is T2N0MX, stage 2 disease.