scott@vtx-cpd.com

Replying to Hilary J. 18/10/2024 - 14:55

Hello Hilary!

We are so lucky to have you as part of our course,

Thank you so much for your contribution.

Scott 🙂

Replying to Megan S. 16/10/2024 - 17:04

Hi Megan,

Thank you for your kind words! I’m glad you’re finding the course helpful and interesting.

To answer your question, differentiating between adrenal-dependent hyperadrenocorticism (ADH) and pituitary-dependent hyperadrenocorticism (PDH) can be important, but it’s not always essential, especially if the treatment plan may not change. Here’s a breakdown:

Clinical Importance of Differentiation:

PDH is more common (about 80-85% of cases), and medical therapy like trilostane or mitotane can effectively manage both PDH and ADH.
ADH can be more aggressive, particularly if there is a functional adrenal tumor. In these cases, surgery (adrenalectomy) may be curative. Differentiating ADH from PDH helps identify whether surgery should be considered as a more definitive option.
When to Differentiate:

If imaging or clinical signs suggest an adrenal mass, it may be worth investigating further, as adrenal tumors could require more specific management. I suppose that it is good to know if there is an adrenal mass as it may be something that needs careful monitoring with ultrasound and could even be an indication for surgical removal.
The other indication would be if there is a growing pituitary mass, which could require intervention. In cases of macroadenomas, there may be indications for radiation therapy or even surgical removal of the pituitary. This can be more of a concern if neurological signs develop or the tumor is compressing nearby structures. What are your thoughts on this?
Investigating:

Differentiation tests (such as endogenous ACTH or imaging) can sometimes give unclear results, which is frustrating.
In straightforward cases where medical therapy is working well, it may not always be necessary to push for a definitive diagnosis, especially if there’s no suspicion of an adrenal or pituitary mass.
In summary, while it’s not always necessary to differentiate between ADH and PDH when clinical signs are well controlled with medical therapy, there are situations—like with adrenal masses or growing pituitary tumors—where knowing which form is present becomes more important. Monitoring with imaging and considering interventions such as surgery or radiation might be key in such cases.

Let me know if you have any further questions!

Best regards,

Scott 🙂

Replying to Hannah B. 14/10/2024 - 23:01

Hi Hannah,

Thank you for contributing to the discussion. It’s encouraging to hear how follow-up emails are enhancing client engagement by reinforcing information discussed in consultations. Providing a written summary indeed fosters trust and helps clients better understand the rationale behind diagnostic tests and treatments.

Your approach of including an email footer with availability details and reminders about contacting reception is an excellent strategy for managing expectations. It’s a professional way to establish boundaries and guide clients on communication channels.

I use a dictation software called Talkatoo, which allows me to dictate directly onto the computer using a microphone. It has been a valuable tool for transcribing conversations and maintaining accurate records. I also often dictate into ChatGPT to help refine and clarify my thoughts—especially when they’re a bit scattered!

Thank you again for sharing your insights.

Best regards,

Scott