CASE 4 House Wife with Polyuria and Polydipsia

CASE 4 House Wife with Polyuria and Polydipsia

• B. B. is a 35 -year-old housewife having symptoms of polyuria, polydipsia, polyphagia and hyperglycemia. She gives a history of a 70 lb. weight gain over the last 8 years, easy bruisability, and irregular menses.

On Examination • Has generalized obesity, with normal hair distribution, and no evidence of masculinization. • BP 150/102 and other vital signs are normal. She has mild facile plethora, but did not have dorsal or supreclavicular fat pad fullness. • The skin is normal in thickness and there are no bruises. • There are no violaceous striae, and she has no peripheral edema

• Overnight • She was treated with diet dexamethasone >> AM and insulin and after cortisol 18 ug/dl education was discharged (normal<5 ug/dl) for further evaluation in • Urine free cortisol - 201 the endocrinology clinic ug/2 hrs. • Other data: Dexamethasone suppression: low dose - no suppression, high dose - suppression • ACTH normal: AM > 140 pg/ml; PM about 1/2 - 2/3 AM value).

This reveals a gradient of ACTH levels between the peripheral sample and the petrosal sinus sample which strongly suggests that the ACTH over-production is of pituitary origin. • Inferior petrosal sinus sampling: • peripheral ACTH 133 pg/ml • L inf. petr. ACTH 128 pg/ml • R inf. petr, ACTH 3033 pg/ml

• Transsphenoidal surgery was performed, and a small mass was discovered in the right lobe of the pituitary. Postoperatively, she required brief treatment with DDAVP for transient Diabetes insipidus. • Urine cortisol became normal. Over the year after surgery, she lost 80 lbs, and her requirement for insulin decreased from 80 units NPH daily to 0. • Your Diagnosis ? • Diabetes secondary to pancreatitis • Diabetes secondary to insulinoma • Diabetes secontary to pituitary adenoma

• Diabetes secondary to pituitary adenoma. • This patient had an adenoma of the pituitary with over production of ACTH.