What is the most appropriate next step in management?

A 28-year-old woman was referred with an 8-year history of progressive weight gain, hypertension and abdominal striae. She had no family history of note and was not taking any medication.

On examination, her blood pressure was 158/86 mmHg. There was central obesity with abdominal striae. There was mild proximal myopathy of the lower limbs.

Investigations:

serum sodium143 mmol/L (137C144)

serum potassium3.4 mmol/L (3.5C4.9)

low-dose dexamethasone suppression test (2 mg/day for 48 h):

serum cortisol180 nmol/L (<50)

An MR scan of pituitary showed an invasive adenoma extending laterally into the cavernous sinuses bilaterally. Superiorly, the adenoma was in contact with, but not

distorting, the optic chiasm. Formal visual field examination was normal.

What is the most appropriate next step in management?
A . adrenolytic therapy
B . bilateral adrenalectomy
C . pituitary radiotherapy
D . somatostatin agonist therapy
E . trans-sphenoidal hypophysectomy

View Answer

Answer: E