Other tests.
Radio-labelled otreotide to locate ectopic ACTH
Plasma ACTH >200ng/L
Frank Diabetes
Hypokalaemia
48 Hr Dexamethasone Test (High Dose)
Failure of Significant Cortisol Suppression.
Chest X-Ray
Bronchial Carcinoid
CT-Lung, Mediastinum and Abdomen
MRI/CT Scan
Bilateral Adrenal Hyperplasia
Pituitary
Anotações:
Other Tests
Catheterization of inferior petrosal sinus to measure ACTH for pituitary lesions.
Adenoma
MRI/CT Scan
Cushing Disease
CRH Test
Anotações:
In response to exogenous CRH, Exaggerated ACTH and Cortisol Response is soon.
NON-ACTH
Adrenal
CT/MRI Scan
Tumour
48 Hr Dexamethasone Test (High Dose)
Failure of Significant Cortisol Suppression.
Adenoma
Nodular Hyperplasia
Treatment
Pre-operative Control
METYRAPONE 750g to 4g Daily (TDS/QDS)
KETOCONAZOLE 200mg TDS
Monitor Plasma Coritsol
Pituitary Dependent
Trans-sphenoidal Adenomectomy
External Irradiation
When surgery fails
Medical Therapy
Reduce ACTH levels
Bromocriptine
Cabergoline
Bilateral Adrenalectomy (Laparoscopic)
Last Resort
NELSON SYNDROME
Anotações:
Enlarged Pituitary, Increased ACTH production
Excessive Pigmentation.
Can be reduced by performing a pituitary radiotherapy after bilteral adrenalectomy.