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Abstract
General physical examination revealed typical acromegalic features of the face [Figure 1]a, hands, and feet while a static enhanced magnetic resonance imaging (MRI) examination indicated an empty sella without pituitary adenoma. The MRI result suggested an empty sella associated with pituitary adenoma [Figure 1]b. Adrenal gland computed tomography was performed and indicated the thickened left adrenal nodular [Figure 1]c. Subsequent bilateral inferior petrosal sinus sample (BIPSS) was performed for the localization diagnosis [Figure 1]d, which demonstrated adrenocorticotrophic hormone (ACTH) level of inferior petrosal sinus and femoral vein at 0 min were 691.4 ng/L and 162.9 ng/L, at 5 min were 952.2 ng/L and 172.3 ng/L, respectively; GH level of inferior petrosal sinus and femoral vein at 0 min were 6.34 ng/ml and 3.88 ng/ml, at 5 min were 3.7 ng/ml and 2.38 ng/ml, respectively. [...]dynamic contrast MRI and BIPSS were helpful in diagnosing under these circumstances, as the former test...