Endocrine Abstracts

A 30-year-female with history of progressive weight gain noticed since menarche reduced weight to 104 kilograms from 148 kilograms with lifestyle modifications. Her weight has now become static since the last 1 year. She noticed few extra facial hair and mild acne. She has irregular menstrual cycles for last 4 years, treated with COCs but stopped since last 6 months. She denied any extremity weakness, easy bruising or stretch marks over the body. Her medical history was positive for hypothyroidism (on 300 mg levothyroxine), severe anemia, severe vitamin D deficiency, HLA-B27 positive status. Her GP ordered evaluation for obesity / Cushing disease. Initial biochemical evaluation revealed FT₄ 15 pg/mL (10–22)(CLIA), FSH 234 mIU/mL(CLIA), LH 200 mIU/mL(CLIA), Total Testosterone 127 ng/dl(CLIA), prolactin 319 ng/mL (<25)(CLIA), ACTH 95 pg/mL (<46)(CLIA), 8am serum cortisol 126 µg/dL (5–25)(CLIA), TSH 40 mIU/mL(CLIA)with normal potassium. Additional tests revealed HPLC - β-thalassemia trait, anti-tTG IgG positivity, anti tTG IgA negative, anti-IF positivity, low ferritin. High cortisol / ACTH levels prompted an MRI pituitary which revealed a 3*6 mm anterior pituitary microadenoma, TNTS was planned for Cushing Disease by neurosurgeon. Patient was then referred to Endocrinology Department for perioperative management. On examination patient had abdominal obesity, insulin resistance but no Cushing stigmata. The absence of discriminatory features prompted reevaluation. A LDDST was advised which paradoxically yielded ACTH 145 pg/mL and serum cortisol 240 mg/dL, reinforcing biochemical–clinical discordance. Comprehensive steroid profiling by LC–MS/MS demonstrated normal cortisol / metabolite concentrations, confirming spurious hormonal elevations due to heterophile antibody. Other pituitary hormones were re-evaluated with PEG precipitation and LC-MS/MS methods and hormonal levels were within normal limits. Surgery was withheld and the lesion was reclassified as a non-functioning pituitary incidentaloma.