Daily Archives: July 20th, 2012

Magic Conference, Day 1, Dr. Salvatori (1 of 3)

MEETING NOTES : Dr. Salvatori

Meeting Created: July 20, 2012 11:00 AM


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
  • Fat pads
  • Moon face
  • Thin skin
  • Acne
  • Depression
  • Fatigue
  • Weight gain
  • Menstrual
  • Decreased libido
  • Irritability
  • 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

  • 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

  • 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

  • Undiagnosed
  • Gradual symptoms
  • Steroid replacement before thyroid replacement
Q & A

Magic Conference, Day 1: Dr. Frohman


Meeting Created: July 20, 2012 9:00 AM


Understanding your Pituitary Gland in Health and Disease

Dr. Frohman will present an overview of the pituitary gland. He will cover general aspects of
pituitary function and testing and also review the types of pituitary disease that occur,
including pituitary tumors and Sheehan’s Syndrome. Many people ask and wonder if Growth
Hormone Deficiency can be inherited. Dr. Frohman will also briefly address that concern. 


Sheep studies, pulses pulsatile

GH secretion at night, varies with age.  Most in teens then downhill, follows diurnal rhythm

High igf= cancer?

Anterior pituitary
Then back to hypothalamus

Inhibin to inhibit ovary and testes

Types of tumors

Alpha subunit no signs or symptoms 

Microadenoma, macroadenoma

Mass effects
Headache, visual disturbance, neurological damage

Impaired pit function…hypopituitarism


Hands, feet, facial swelling, sleep apnea, snoring, tall, oily skin, increased soft tissue, Goliath, carpal tunnel
TMJ, osteoarthritis
Metabolic changes
Organ enlargement, hypertension

ACTH, cortisol
Acne, hirsuitism, striae, other usual symptoms

Drugs keto, mifepristone, pasireotide
Radiation stereotactic, gamma knife can cause hypopituitarism

  • Primary, Sheehan’s syndrome uncommon today
  • Genetic
  • Trauma
  • Tumor
  • Iatrogenic
  • Traumatic brain injury
  • Anorexia
  • Tumors
  • Steroids

Clinical features

  • Acute
  • Slow

Hypo clinical features

Diagnosis, testing


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