By Pauline M Camacho MD
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It is due to melanocyte-stimulating hormone production as a byproduct of ACTH synthesis from POMC. Laboratory Findings After establishing the diagnosis of CS as detailed in Chapter 3, the next step is to determine if CS is ACTH dependent. m. is indicative of an ACTH-independent etiology, whereas a level above 20 pg/ml is indicative of ACTH dependency. ACTH between 10 and 20 pg/ml is indeterminate but usually indicates an ACTH-dependent etiology [92,93]. When ACTH falls into this indeterminate range, a CRH stimulation test can be helpful with measurement of ACTH.
This stalk compression leads to diminished delivery of hypothalamic hormones and dopamine to pituitary cells. The decrease of hypothalamic hormones may lead to deficiencies of most of the anterior pituitary hormones. indd 12 2/23/2012 8:34:55 PM Hypopituitarism 13 lating PRL. This increased PRL in the context of a non-PRL-secreting pituitary tumor is termed pseudoprolactinoma. The diagnosis is established by finding abnormalities of the subunits of LH and FSH that are characteristic of a gonadotrope adenoma and follow-up imaging by sellar MRI.
Currently, the use of PET imaging in the assessment of pituitary tumors is at the research level. indd 14 2/23/2012 8:34:55 PM Imaging of the Hypothalamic–Pituitary System 15 Figure 1a. Coronal T1-weighted MR image through pituitary fossa showing a pituitary microadenoma with hypo-enhancement of the right pituitary gland (arrow). Figure 1b. Coronal T1-weighted MR image through pituitary fossa showing a pituitary microadenoma elevating and compressing optic chiasm (arrow). indd 15 2/23/2012 8:34:55 PM 16 Chapter 1 • Hypothalamic–Pituitary Disease Other Sellar Lesions Certain pituitary lesions have specific signal characteristics, which may aid in diagnosis.