Just thought that I would share the two notes that changed my life.
"Ted Friedman, MD, PhD"
Just when we thought it was safe to conclude you didn't have cushigns, yourlast ufc was 878 nl < 105 and 17OHS 13.8 nl < 10. It was done atlabcorp. Can you give lynne your fax # and she can fax itPlease collect 4 more ufc and request them sent to esoterix.
Theodore C. Friedman, M.D., Ph.D.
Associate Professor of Medicine-
Charles R. Drew University--
Dear Phil, I'm sorry I had to request your address again, it has slipped somewhere into the vast reaches of my computer and I knew I needed to get back to you on your MRI.
I have had a chance to go over things there, and here is what I think.
The latest scan (on the disc, from 09/06) is the one with best quality, and it shows an abnormal pituitary gland. The stalk is tilted to the left, a bit more than is really allowed in normal variation. This would imply a mass of some sort on the right (i.e., opposite) side of the gland.
On the dynamic images, there is a subtle suggestion of just that. The only kicker is that the abnormality isn't confined entirely to the right side of the gland, as there seem to be small patches of low signal, or "hypointensity," present on both right and left side.
In a circumstance such as this, we would consider operating on the pituitary if the hormonal numbers pointed to Cushing's. It's hard to give a specific tumor diagnosis here, but I'd bet that an exploration of the gland would reveal such.
MRIs in Cushing's can be very hard to sort out, some show nicely specific areas of tumor, others show patchy changes such as I see in yours (usually suggestive of tumor but not allowing the surgeon to pin it down to a specific part of the gland prior to surgery) and some show no change at all (yet can still have a tumor hiding within).
Have the numbers that Dr. Friedman has been gathering supported the Cushing's diagnosis as yet? In any case, I don't really agree that the MRI is normal, for the reasons given above....Hope this helps you,
Best regards, Ian McCutcheon