The Trip So Far…
MEETING NOTES : The Trip So Far…
Meeting Created: July 20, 2012 11:56 PM
Lombard
Thursday morning I got up about 5 am to head to the airport. I hadn’t slept much the night before because I always get nervous flying. My first flight was at 9 and left onetime, no problems at all.I got to Boston for the layover. The first thing I needed to do was get cash for the rest of the trip. Unfortunately, the ATM didn’t play nice and no cash came out. I called the number on the machine and got the old “push 1 for…”. I finally figured out what was the right number and I got a recording telling me to call my bank.
So, I had to make another call. I am not a phone person at all so this was not a great way to spend my free time. I finally got through that phone tree and got to a real person. I told him I had a receipt. When I actually looked it, I saw that the machine had never intended to give me any money – I had chosen savings instead of checking account. DUH
This time when I tried, I actually got my cash.
The next plane was over an hour late, waiting for a plane to arrive from DC. Huh? Why did I have to take an earlier flight if there was this later one?
Many babies and toddlers on this flight. The row ahead of me had 2 babies and right across the aisle was a toddler. So much for a nap.
When we got to Chicago, my bag was the third on the carrousel. Unheard of.
I called the shuttle company and the person hung up on me. Called again and the person said I had to wait until 5. I was 3:30. So I wandered around O’Hare a bit and finally went out. The shuttle was about 20 minutes late.
Got to the hotel and Terry came over to greet me. I checked in, took my stuff to my room and back down to the exhibit hall. I saw Sarah (again) and met several new folks, including 2 Corcept nurses. Picked up some cool stuff.
Several of us went to dinner at the hotel then unpacking and bedtime for me.
Friday:
I’m still on eastern time so I woke up earlier than I’d have liked. I couldn’t get back to sleep so I checked email, did some web work.
The first lecture was Dr Frohman. I got a fruit plate and 2 cups of coffee so I wouldn’t have to go get more during his talk. I got to sit next to Denise, who I haven’t seen for several years.
Dr. Frohman’s and all the lectures are available on http://www.cushingshelp.blogspot.com
So far, I’ve been able to get them available within 5 minutes of the end of the lecture-a first for me.
After the break, I found that they’d taken the coffee away. Aacckk! Will have to hoard more tomorrow so I don’t get a headache. Karen had a brilliant idea and she ordered a pot from room service, which we split.
Dr. Salvatori was next, then lunch followed by Dr. Salvatori again (see lecture notes!). Then Dr. Heaney and a bit of a break before dinner. I bought a blue short sleeved golf shirt, the same as Denise.
Back to the room to brush my teeth and off to dinner. It was nice, conference-y food: chicken in a sauce, roast potatoes, beans, carrot, asparagus, salad and a rich apple caramel dessert.
After dinner, the obligatory pictures.
Then off to the mall. I got a sweater. It’s cold in the meeting room!
A few of us went in the pool but there were lots of kids. Maybe tomorrow, when they’re at the zoo…
Night!
Magic Conference, Day 1, Dr. Salvatori (1 of 3)
MEETING NOTES : Dr. Salvatori
Meeting Created: July 20, 2012 11:00 AM
Lombard
Testing and Diagnosis Process for Pituitary Disorders
Pituitary disorders can be difficult to diagnose in many cases. Dr. Salvatori will discuss the
different testing and diagnostic procedures to determine the pituitary disorder. MAGIC
receives many calls asking about diagnostic procedures. This segment will be helpful in under-
standing what procedures are used today to provide the best treatment available.
Dr. Cushing picture
Dr. S only sees diagnosed patients
Dr C 1932 description from Johns Hopkins, pre-MRI
Causes do CS
- Prescriptions, iatrogenic
- ACTH independent adrenal 20%
- ATCH dependent, 80%, 85%of those Cushings
Signs best to discriminate
- Bruisings
- Facial plethora, redness
- Weakness
- Striae
Symptoms
- Fat pads
- Moon face
- Thin skin
- Acne
- Depression
- Fatigue
- Weight gain
- Menstrual
- Decreased libido
- Irritability
diagnosis
- UFC
- Overnight sex
- Salivary
- Dex-CRF
Why bedtime cortisol?
Diurnal rhythm, changing time zones, what helps you wake up
Is CS ACTH-dependent?
Where is the ACTH coming from?
- Up to 30% not visible on MRI
- Up to 10% of normal people suggest pituitary incidentaloma
- MRI is not good test to diagnose
First do no harm, be sure before surgery
IPSS, not to diagnose Cushings, just to find where ACTH is coming from
Lose more blood testing for Cushings than during surgery
Prolactinoma vs. pseudo-prolactinoma
- Pregnant
- Psychoactive drugs
Acromegaly: IGF-1 not whole story
Hugo brothers
Hypopituitarism
- Many undiagnosed
- 45/100,000 from Spanish study
- 94/100,000 from Belgian
Secondary, TSH isn’t a good test
Testicle size
Adrenal insufficiency
AM cortisol less then 3 ug/dl
Random cortisol above 15 ug/dl rules it out
Tests
- ITT
- ACTH stimulation
Adrenals shrink
Pituitary apoplexy=acute adrenal insufficiency
GH deficiency
IGF-1 not good test
Glucagon used now at Hopkins. Cutoff is 3
Heavier you are, lower GH on stimulation test
Pan-hypopituitary don’t need stimulation testing
Causes of hypopituitary
Traumatic brain injury, mostly young men
Cancer, radiation to brain
Hypopituitary
- Undiagnosed
- Gradual symptoms
- Steroid replacement before thyroid replacement
Q & A
