Internal Medicine

Pituitary Disorders

Questions discussed in this category

Do you interpret failure to develop hypernatremia with prolonged water deprivation (such as for 12 hours) as evidence against diabetes insipidus even if the urine osmolality is just below normal?

For a patient whose sodium remains 142 despite water deprivation from 8 pm to 8 am, with urine osm of about 500, is further testing needed?

1 Answer available

When do you consider using setmelanotide for treatment of hypothalamic obesity?

2 Answers available

How do you approach mild prolactin elevations (20-80) in women with galactorrhea on nipple stimulation but regular menses and no plans for pregnancy?

1 Answer available

Would you consider treating empirically for AVP deficiency in a patient who had pituitary surgery 6 months earlier and complaints of polyuria/polydipsia with dilute urine (without performing water deprivation studies)?

2 Answers available

Do you have any specific recommendations to prevent large fluctuations in sodium levels during a colonoscopy prep in patients with central diabetes insipidus on DDAVP?

3 Answers available

For patients with central hypothyroidism and a clear etiology (such as recent head irradiation), do you recommend brain imaging prior to starting thyroid hormone replacement therapy?

2 Answers available

Should dopamine agonist treatment stop in pregnant patients with recurrent prolactinoma despite prior surgery?

1 Answer available

What specific clinical factors would drive you to recommend surgical intervention for patients with small, nonfunctional pituitary adenomas who exhibit no neurological symptoms?

1 Answer available

When and how do you taper off cabergoline therapy for treatment of microprolactinoma?

1 Answer available

What is your approach to managing patients with new laboratory evidence of hypopituitarism (e.g. very low plasma ACTH level and low morning serum cortisol) and a remote history of trans-sphenoidal surgery for NFPA?

1 Answer available

Does growth hormone (GH) replacement therapy reduce the risk of fractures in patients with GH deficiency?

1 Answer available

Is Macrilen (macimorelin Dx) still available in the US for diagnosis of adult growth hormone deficiency (AGHD)?

1 Answer available

Should patients with non-functional pituitary macroadenomas with persistent, but tolerable, headaches be recommended for surgery?

1 Answer available

Given the new 2022 WHO classification of pituitary tumors, should we be regularly counseling our patients about the risk of malignancy for what we previously referred to as pituitary adenomas but now classified as pituitary neuroendocrine tumors (PitNETs)?

Asa et al., PMID 35291028

1 Answer available

What is your approach to differentiating diabetes insipidus from primary polydipsia in the outpatient setting?

1 Answer available

Does preoperative use of somatostatin receptor ligand improve remission rates after surgery for acromegaly?

1 Answer available

When do you check macroprolactin in the evaluation of hyperprolactinemia?

2 Answers available

Does norethindrone suppress FSH, LH completely?

If not, what can be possible causes for a postmenopausal woman to have FSH, LH < 0.3 with low E2, and being asymptomatic and doing well otherwise? ...

2 Answers available

Do patients with an elevated IGF-1 level and features of acromegaly need to have confirmatory growth hormone suppression testing with OGTT?

Can a diagnosis of acromegaly be made with just an elevated IGF-1 level in patients with features of acromegaly?

2 Answers available

Should oral combined contraceptives be held prior to overnight dexamethasone suppression test to rule out Cushings?

If so, how long should OCPs be held to reliably trust the dex suppression test results?

2 Answers available

Can combined oral contraceptive use cause falsely elevated 24-hour urine-free cortisol?

2 Answers available

What is your protocol to starting/stopping glucocorticoid replacement in Cushing disease patients after their transsphenoidal resection surgery?

1 Answer available

How often would you repeat testing in a patient suspected of Cyclic Cushing's?

And is there a preferred diagnostic test? Whenever cyclic hypercortisolemia is suspected, it is advised that evaluation should be repeated for months,...

2 Answers available

For a TSH producing microadenoma, would you recommend surgery vs methimazole if the patient is elderly and the tumor is relatively small?

The female patient is in her late 70s with cardiac disease (likely due to chronic hyperthyroidism that was missed due to non-suppressed TSH). I’...

1 Answer available

Should patients with asymptomatic GH deficiency be treated with GH replacement therapy if they have prior known severe CAD?

1 Answer available

Does caution have to be used in GH replacement therapy in any and all types of cancer history?

1 Answer available

Papers discussed in this category

The lancet. Diabetes & endocrinology, 2021 Oct 20

Consensus on diagnosis and management of Cushing's disease: a guideline update.

Pituitary, 2022 May 26

The NETting of pituitary adenoma: a gland illusion.

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