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

She was treated with diet and insulin and after education was discharged for further evaluation in the endocrinology clinic Overnight dexamethasone >> AM cortisol 18 ug/dl (normal<5ug/dl) Urine free cortisol 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 ?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.