Chandigarh,11.12.19-Dr Rama Walia received the prestigious PN Shah oration from the Endocrine society of India during its annual conference held at Nagpur. This oration was awarded for the work on Cushing’s syndrome which is a disorder associated with increased secretion of cortisol. Excessive cortisol production leads to excessive weight gain , hypertension , osteoporosis with muscle weakness. This is one of the most enigmatic endocrine disorder with difficulties starting from establishing its diagnosis to finding its cause. The usual tumors which lead to this syndrome are less that a cm in size and are difficult to locate.

This work was done in collaboration with the department of nuclear medicine and radiodiagnosis at PGIMER. Endogenous Cushing's syndrome is a clinical state resulting from inappropriate and excess endogenous production of cortisol. This syndrome may arise due to excessive ACTH production from the pituitary gland, ectopic ACTH secretion from a non pituitary source, autonomous cortisol secretion from adrenal glands and rarely by ectopic CRH production. The incidence of Cushing's syndrome is 1.2-2.4 cases/million/year and 70-80% are due to Cushing's disease, of which 90% are caused by microadenoma majority being less than 6 mm.Visualizing these tumours in a 10 mm pituitary and confirming its functional status is challenging. In a patient with clinically and biochemically confirmed endogenous Cushing's syndrome, the long term remission is determined by the correct functional and anatomical delineation of corticotropinoma i.e. to distinguish between Cushing's disease and ectopic ACTH production and preoperative visualization of the tumour, respectively. None of the available diagnostic modalities can localize and confirm functionality of a corticotropinoma simultaneously. The work started from establishing which test is the most useful to establish its diagnosis and culminated in developing a novel integrated functional and anatomical imaging with Ga68 CRH PET/CT forthe detection of pituitary adenoma in ACTH dependent Cushing’s syndrome. This work helps to make the diagnosis of this disorder , find out the responsible tumour and there by facilitating the removal of the causative adenoma.

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