@nicolas_diaz_equestrian: I love my Boy! #PRE #Stallion

Nicolas_Diaz

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Saturday 26 September 2020 14:19:09 GMT

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Lorrie Cummins :

# beautiful

2020-09-26 15:06:38

2

user irene-snooepije :

stunning

2020-09-27 06:43:53

2

Julie :

He’s such a beautiful horse

2020-10-29 03:00:25

2

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なんなんこれwww 会話が成り立ってるのおかしすぎやろ笑マンボとハチミてww #mytipe #推し #運営さん大好き #おすすめ #感動 #推し活 #ウマ娘

なんなんこれwww 会話が成り立ってるのおかしすぎやろ笑マンボとハチミてww #mytipe #推し #運営さん大好き #おすすめ #感動 #推し活 #ウマ娘

Replying to @kath hamel Case Study 187: Cushing’s Disease Cushing’s disease is a specific form of Cushing’s syndrome caused by a pituitary adenoma that secretes excess adrenocorticotropic hormone (ACTH) — driving the adrenal glands to produce excess cortisol. 📊 Facts & Figures: • Cushing’s disease accounts for 60–70% of endogenous Cushing’s syndrome cases. • It is 3–5 times more common in women, especially between the ages of 20–40. • Average tumor size is 5 mm, often invisible on MRI — making diagnosis challenging. • Median diagnostic delay is 2–5 years due to subtle, overlapping symptoms. 🩺 Symptoms include: • Central weight gain, moon face, dorsocervical fat pad (“buffalo hump”) • Hypertension, glucose intolerance/diabetes, hirsutism, muscle weakness • Menstrual irregularities, mood swings, osteoporosis, and skin fragility (purple striae, bruising) 🧪 Diagnosis involves: • 1 mg low-dose dexamethasone suppression test • 24-hour urinary free cortisol • Late-night salivary cortisol • If ACTH is elevated, pituitary MRI and Inferior Petrosal Sinus Sampling (IPSS) help localize the source. 🔪 Treatment: First-line is transsphenoidal surgery to remove the adenoma. • Long-term remission rates: 65–85% after initial surgery • Recurrence rate: up to 20–25% over time • For persistent disease: radiation, medical therapy (e.g., ketoconazole, mifepristone), or bilateral adrenalectomy 💡 Why it matters: Left untreated, chronic cortisol elevation increases cardiovascular mortality, worsens mental health, and severely impacts quality of life. But early diagnosis and expert surgical care can lead to remission and recovery. #CushingsDisease #Endocrinology #PituitaryTumor #LadySpineDoc #SundayCaseStudy

Replying to @kath hamel Case Study 187: Cushing’s Disease Cushing’s disease is a specific form of Cushing’s syndrome caused by a pituitary adenoma that secretes excess adrenocorticotropic hormone (ACTH) — driving the adrenal glands to produce excess cortisol. 📊 Facts & Figures: • Cushing’s disease accounts for 60–70% of endogenous Cushing’s syndrome cases. • It is 3–5 times more common in women, especially between the ages of 20–40. • Average tumor size is 5 mm, often invisible on MRI — making diagnosis challenging. • Median diagnostic delay is 2–5 years due to subtle, overlapping symptoms. 🩺 Symptoms include: • Central weight gain, moon face, dorsocervical fat pad (“buffalo hump”) • Hypertension, glucose intolerance/diabetes, hirsutism, muscle weakness • Menstrual irregularities, mood swings, osteoporosis, and skin fragility (purple striae, bruising) 🧪 Diagnosis involves: • 1 mg low-dose dexamethasone suppression test • 24-hour urinary free cortisol • Late-night salivary cortisol • If ACTH is elevated, pituitary MRI and Inferior Petrosal Sinus Sampling (IPSS) help localize the source. 🔪 Treatment: First-line is transsphenoidal surgery to remove the adenoma. • Long-term remission rates: 65–85% after initial surgery • Recurrence rate: up to 20–25% over time • For persistent disease: radiation, medical therapy (e.g., ketoconazole, mifepristone), or bilateral adrenalectomy 💡 Why it matters: Left untreated, chronic cortisol elevation increases cardiovascular mortality, worsens mental health, and severely impacts quality of life. But early diagnosis and expert surgical care can lead to remission and recovery. #CushingsDisease #Endocrinology #PituitaryTumor #LadySpineDoc #SundayCaseStudy

@melodysusie is so mid at this point I’ve gotten a couple and not worth it, I got another one from a different brand that lasted me over a year but I can get these melodysusie drills not to break down.

#مجرد________ذووووووق🎶🎵 〘الأنــ✌︎ـيـــــ💙ــق〙#🚬🖤🥃

#مجرد________ذووووووق🎶🎵 〘الأنــ✌︎ـيـــــ💙ــق〙#🚬🖤🥃

25k perhari bersaing sama vario 🗿🥲 #fypp #vario125 #nabung #sekolah #vario

25k perhari bersaing sama vario 🗿🥲 #fypp #vario125 #nabung #sekolah #vario

Respuesta a @robertjoelsalazar igualitos #jonathanmaicelo #bryanarambulo #rinoplastia #elratingmanda

Respuesta a @robertjoelsalazar igualitos #jonathanmaicelo #bryanarambulo #rinoplastia #elratingmanda

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