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PDES Patient Survey

Thank you for taking the time to help the PDES gather information that will help us build a resource list for patients and reach physicians who need information about pituitary disorders.

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* First Name:
* Last Name:
* Street Address:
* City:
* State/Canadian Province:
* Postal Code:
* Country:
* E-Mail Address:

What is your type of pituitary disorder?
Acromegaly
Cushing's
Prolactinoma
Non-secreting/null cell/ or nonfunctioning tumor
Rathke Cleft Cyst
Chraniopharynginoma
Sheehan's Syndrome
Lymphocytic Hypophysitis
Other
What symptoms prompted you to seek medical help?
Type of treatment you received for your diagnosis?

What medications are you currently taking?

Surgery. If so, was it successful in removing all of the tumor cells?
Radiation If so were you treated for any hormone deficiencies?

Which hormones are you deficient in?
GH
TSH
ACTH
FSH
LH


What type of specialist diagnosed your pituitary condition?



Are you currently seeing a specialist for your treatment or follow up care?
  What type of medical specialist are you seeing now?
 
How often do you have your hormone levels tested?

Which blood test did your physician order to reach a diagnosis?
GH
IGF-1
Growth Hormone Stimulation test
TSH
T-4
T-3
ACTH
Cortisol
Blood
Urine Dexamethasone suppression
FSH
LH
Estrodial
Progesterone
Testosterone
Which blood test does your physician currently order?
GH
IGF-1 or ( Somatomedin-C)
IGF-Bp 3
TSH
T-4
T-3
T-4, Free
T-3, Free
ACTH
Cortisol
Blood
Urine
FSH
LH
Estradiol
Progesterone
Testosterone
DHEA
Pregnenalone
Cholesterol
Insulin
Osteocalcin

Who are you seeing now for your treatment i.e. prescriptions. blood test and MRI's & bone density scans ?
Specialty:
Country:

Do you feel you are being treated for all of your symptoms?
  If not what symptoms persist?
 
  Please list physicians you would like to recommend for other pituitary patients.
 
  Please list physicians you would like to receive information about how to treat pituitary disorders.
 



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