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Table 3 Timeline of events with diagnostic tests and interventions

From: Apoplexy of Crooke cell tumour leading to the diagnosis of severe Cushing disease; a case report

Month/year

Events

Diagnostic tests

Interventions

2009

Secondary amenorrhoea

None

None

From beginning of 2019

weight gain, darkening of skin, multiple acne and difficulty in getting up from squatting position

None

None

August/2019

Sudden onset headache and blindness

Visual assessment: complete blindness of left eye and finger counting from right eye with temporal visual loss

MRI-pituitary: giant pituitary tumour with bleeding

Biochemistry: hypokalaemia, elevated cortisol, central hypothyroidism, low FSH, LH

Trans-sphenoidal excision of the pituitary tumour

Histology: Crooke cell tumour

Started levothyroxine and hydrocortisone replacement

November/2019

Follow up

MRI-pituitary: No residual tumour

Visual field: bitemporal hemianopia (improved)

Twenty four hour urinary cortisol: normal

9 am cortisol: 181 nmol/L

Started cyclical oestrogen and progesterone, levothyroxine continued

September/2020

Follow up

MRI-pituitary: No residual tumour

Twenty four hour urinary cortisol: normal

Continued same treatment