Saturday, July 21, 2012

The Trip So Far...

MEETING NOTES : The Trip So Far...

Meeting Created: July 20, 2012 11:56 PM


Thursday morning I got up about 5 am to head to the airport.  I hadn't slept much the night before because I always get nervous flying.  My first flight was at 9 and left onetime, no problems at all.

I got to Boston for the layover. The first thing I needed to do was get cash for the rest of the trip.  Unfortunately, the ATM didn't play nice and no cash came out.  I called the number on the machine and got the old "push 1 for...". I finally figured out what was the right number and I got a recording telling me to call my bank.

So, I had to make another call.  I am not a phone person at all so this was not a great way to spend my free time.  I finally got through that phone tree and got to a real person.  I told him I had a receipt.  When I actually looked it, I saw that the machine had never intended to give me any money - I had chosen savings instead of checking account. DUH

This time when I tried, I actually got my cash.

The next plane was over an hour late, waiting for a plane to arrive from DC. Huh?  Why did I have to take an earlier flight if there was this later one?

Many babies and toddlers on this flight. The row ahead of me had 2 babies and right across the aisle was a toddler.  So much for a nap.

When we got to Chicago, my bag was the third on the carrousel.  Unheard of.
I called the shuttle company and the person hung up on me.  Called again and the person said I had to wait until 5. I was 3:30.  So I wandered around O'Hare a bit and finally went out.  The shuttle was about 20 minutes late.

Got to the hotel and Terry came over to greet me.  I checked in, took my stuff to my room and back down to the exhibit hall.  I saw Sarah (again) and met several new folks, including 2 Corcept nurses.  Picked up some cool stuff.  

Several of us went to dinner at the hotel then unpacking and bedtime for me.


I'm still on eastern time so I woke up earlier than I'd have liked.  I couldn't get back to sleep so I checked email, did some web work.

The first lecture was Dr Frohman. I got a fruit plate and 2 cups of coffee so I wouldn't have to go get more during his talk.  I got to sit next to Denise, who I haven't seen for several years.

Dr. Frohman's and all the lectures are available on 

So far, I've been able to get them available within 5 minutes of the end of the lecture-a first for me.

After the break, I found that they'd taken the coffee away.  Aacckk!  Will have to hoard more tomorrow so I don't get a headache.  Karen had a brilliant idea and she ordered a pot from room service, which we split.

Dr. Salvatori was next, then lunch followed by Dr. Salvatori again (see lecture notes!). Then Dr. Heaney and a bit of a break before dinner.  I bought a blue short sleeved golf shirt, the same as Denise.

Back to the room to brush my teeth and off to dinner.  It was nice, conference-y food:  chicken in a sauce, roast potatoes, beans, carrot, asparagus, salad and a rich apple caramel dessert.

After dinner, the obligatory pictures.  

Then off to the mall.  I got a sweater.  It's cold in the meeting room!  

A few of us went in the pool but there were lots of kids.  Maybe tomorrow, when they're at the zoo...



Posted via email from MaryO'Stuff

Friday, July 20, 2012

Magic Conference, Day 1, Dr. Salvatori (1 of 3)

MEETING NOTES : Dr. Salvatori

Meeting Created: July 20, 2012 11:00 AM


Testing and Diagnosis Process for Pituitary Disorders 

Pituitary disorders can be difficult to diagnose in many cases. Dr. Salvatori will discuss the

different testing and diagnostic procedures to determine the pituitary disorder. MAGIC
receives many calls asking about diagnostic procedures. This segment will be helpful in under-
standing what procedures are used today to provide the best treatment available. 

Dr. Cushing picture

Dr. S only sees diagnosed patients

Dr C 1932 description from Johns Hopkins, pre-MRI

Causes do CS
  • Prescriptions, iatrogenic
  • ACTH independent adrenal 20%
  • ATCH dependent, 80%, 85%of those Cushings
Signs best to discriminate
  • Bruisings
  • Facial plethora, redness
  • Weakness
  • Striae
  • Fat pads
  • Moon face
  • Thin skin
  • Acne
  • Depression
  • Fatigue
  • Weight gain
  • Menstrual
  • Decreased libido
  • Irritability
  • UFC
  • Overnight sex
  • Salivary
  • Dex-CRF
Why bedtime cortisol?

Diurnal rhythm, changing time zones, what helps you wake up

Is CS ACTH-dependent?

Where is the ACTH coming from?
  • Up to 30% not visible on MRI
  • Up to 10% of normal people suggest pituitary incidentaloma
  • MRI is not good test to diagnose
First do no harm, be sure before surgery

IPSS, not to diagnose Cushings, just to find where ACTH is coming from 

Lose more blood testing for Cushings than during surgery

Prolactinoma vs. pseudo-prolactinoma
  • Pregnant
  • Psychoactive drugs
Acromegaly: IGF-1 not whole story

Hugo brothers

  • Many undiagnosed
  • 45/100,000 from Spanish study
  • 94/100,000 from Belgian
Secondary, TSH isn't a good test
Testicle size

Adrenal insufficiency
AM cortisol less then 3 ug/dl
Random cortisol above 15 ug/dl rules it out

  • ITT
  • ACTH stimulation
Adrenals shrink

Pituitary apoplexy=acute adrenal insufficiency

GH deficiency
IGF-1 not good test
Glucagon used now at Hopkins.  Cutoff is 3
Heavier you are, lower GH on stimulation test

Pan-hypopituitary don't need stimulation testing

Causes of hypopituitary
Traumatic brain injury, mostly young men
Cancer, radiation to brain

  • Undiagnosed
  • Gradual symptoms
  • Steroid replacement before thyroid replacement
Q & A

Posted via email from MaryO'Stuff

Magic Conference, Day 1: Dr. Frohman


Meeting Created: July 20, 2012 9:00 AM


Understanding your Pituitary Gland in Health and Disease

Dr. Frohman will present an overview of the pituitary gland. He will cover general aspects of
pituitary function and testing and also review the types of pituitary disease that occur,
including pituitary tumors and Sheehan’s Syndrome. Many people ask and wonder if Growth
Hormone Deficiency can be inherited. Dr. Frohman will also briefly address that concern. 


Sheep studies, pulses pulsatile

GH secretion at night, varies with age.  Most in teens then downhill, follows diurnal rhythm

High igf= cancer?

Anterior pituitary
Then back to hypothalamus

Inhibin to inhibit ovary and testes

Types of tumors

Alpha subunit no signs or symptoms 

Microadenoma, macroadenoma

Mass effects
Headache, visual disturbance, neurological damage

Impaired pit function...hypopituitarism


Hands, feet, facial swelling, sleep apnea, snoring, tall, oily skin, increased soft tissue, Goliath, carpal tunnel
TMJ, osteoarthritis
Metabolic changes
Organ enlargement, hypertension

ACTH, cortisol
Acne, hirsuitism, striae, other usual symptoms

Drugs keto, mifepristone, pasireotide
Radiation stereotactic, gamma knife can cause hypopituitarism

  • Primary, Sheehan's syndrome uncommon today
  • Genetic
  • Trauma
  • Tumor
  • Iatrogenic
  • Traumatic brain injury
  • Anorexia
  • Tumors
  • Steroids
Clinical features
  • Acute
  • Slow
Hypo clinical features

Diagnosis, testing


Posted via email from MaryO'Stuff