Endocrine Abstracts

A 19 years old student from Bahrain,she has Diabetes mellitus Type II on metformin tablet twice daily for two and half years, she has hypertension uncontrolled on Coveram 5/5 perindopril/amlodipine increased twice daily but still uncontrolled. She has presented with subclinical hypothyroidism TSH is high above 5 and normal T₄. Clinically she has mild abdominal obesity, acne, and mood changes.

Investigations: FBS 7.3 urea 2.9 Cortisol 769.3 at 0800 h. Short Dexamethasone suppression test failed to keep cortisol level normal, while high dose 48 hours dexamethasone suppression test reverted to normal. ACTH 53 pg/ml normal is below 46. MRI done normal. It was mistake they did MRI brain only although request was clear. MRI pituitary Micro adenoma. So referred to neurosurgery (surgery microscopic) done. After surgery patient blood pressure was well controlled, she stopped anti Hypertension and diabetic medications. She was temporally on cortef tablet 10-5-5. Following sequence in endocrine treatment is very successful in treating patients.

Discussion: Dose this patient needs further tests or what was done is enough. Is this situation every time or there is challenges in treatment.