... with the pituitary being confirmed as the source of ACTH although her pituitary imaging is unimpressive ...
Has a CRH test been performed to evaluate ACTH response ?
Best regards,
Mike
Priv.-Doz. Dr. med. Michael Steiner
Medizinisches Labor Rostock
Suedring 81
D-18059 Rostock
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Von: Clinical biochemistry discussion list [mailto:[log in to unmask]] Im Auftrag von Javier Gomez
Gesendet: Freitag, 22. Juli 2011 12:05
An: [log in to unmask]
Betreff: CRH assay?
Hello,
Can anyone analyse CRH? It is not in Assay Finder, and I already have contacted some endocrine labs.
This is an interesting patient, who has now had three cutaneous neuroendocrine tumours resected which were thought originally to be isolated, but may in fact be metastatic deposits from a small bowel primary. There are still a couple of lesions visible on cross sectional imaging, but octerotide and MIBG scanning are both negative.
Over the last few months she has also developed ACTH dependent Cushing’s, with the pituitary being confirmed as the source of ACTH although her pituitary imaging is unimpressive. Though this could be explained by MEN1 – a pituitary and neuroendocrine tumour, though no parathyroid disease detected). An alternative explanation is that her neuroendocrine tumour is secreting CRH driving her otherwise normal pituitary to oversecrete ACTH etc.
She has been referred for pituitary surgery but if she has ongoing ectopic CRH production, it might be that it should cancelled or adrenal surgery considered instead.
Many thanks,
Javier Gomez
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