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PMC3833195_02
Preoperative MRI.
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fig1
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.
Postoperative MRI at 2 years follow-up.
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fig2
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).
UFC and weight over time.
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fig3
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).
HbA1c variations over time.
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fig4
The patient's HbA1c level persisted below 7.0% (Figure 4).