title: Do We Need Hormonal Screening In Patients With Subcentimeter Pituitary Microadenomas?
abstract: A 54-year-old woman came to our endocrinology clinics presenting with upper and lower extremity paresthesia, salt cravings, episodes of hypotension, fatigue and a long term history of depression. Physical exam was unremarkable. Cervical and brain MRI ordered by her neurologist three years ago revealed sella and pituitary normal in size, stable very small 3 mm pituitary incidentaloma and mild disc bulging. Basal pituitary hormonal screening showed low cortisol and ACTH levels. Insulin Tolerance Test and Glucagon Stimulation Test confirmed secondary ACTH deficiency with concomitant GH deficiency. In spite of medical counseling the patient refused glucocorticoid replacement. Due to the non-specific symptoms of this condition it remains a challenge to be diagnosed by clinicians. In conclusion: Our case shows that hormonal deficiencies may occur in small tumors less than 6 mm.
authors.forename: José Hernán
authors.initials: JH
authors.lastname: Martínez-Méndez
authors.forename: Madeleine
authors.initials: M
authors.lastname: Gutiérrez-Acevedo
authors.forename: Coromoto
authors.initials: C
authors.lastname: Palermo-Garofalo
authors.forename: María de Lourdes
authors.initials: Mde L
authors.lastname: Miranda-Adorno
authors.forename: Michelle
authors.initials: M
authors.lastname: Mangual-García
authors.forename: Alfredo
authors.initials: A
authors.lastname: Sánchez-Cruz
authors.forename: Carmen
authors.initials: C
authors.lastname: Rivera-Anaya
authors.forename: Paola
authors.initials: P
authors.lastname: Mansilla-Letelier
authors.forename: Ivan
authors.initials: I
authors.lastname: Laboy-Ortiz
mesh_terms: D000236:Adenoma / Q000378:metabolism* / Q000473:pathology; D000324:Adrenocorticotropic Hormone / Q000172:deficiency* / Q000378:metabolism; D005260:Female; D005934:Glucagon; D019382:Human Growth Hormone / Q000172:deficiency* / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000172:deficiency* / Q000378:metabolism; D007018:Hypopituitarism / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000378:metabolism* / Q000473:pathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D063189:Symptom Assessment; D016312:Treatment Refusal; D047368:Tumor Burden
chemical_list: D019382:Human Growth Hormone; D000324:Adrenocorticotropic Hormone; D005934:Glucagon; D006854:Hydrocortisone