By Mark E Molitch
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Additional resources for Challenging cases in endorinology
Axillary and pubic hair were diminished. There was no increased pigmentation over mucous membranes or the skin. Eye exam revealed normal extraocular movement, pupillary reactions, visual fields, and fundi. Deep tendon reflexes were normal. 6 mg/dL. The hematocrit was 33% and the WBC was 3800/µL. 2–7). A magnetic resonance imaging scan (MRI) of the sella turcica showed an enhancing sellar mass that extended into the suprasellar area, and was close to, but not in contact with the optic chiasm or the cavernous sinus.
The most clinically important deficit is that of ACTH because it leads to acute glucocorticoid insufficiency at a time of severe physical stress. In that respect, the patient under discussion had what appeared to be a “normal “ serum cortisol at a time when he was extremely stressed. ” The vast majority of patients present with at least partial hypopituitarism (1,2). It is important to point out that many patients would be expected to have hypopituitarism even before the apoplectic episode, because practically all have large tumors (1,2).
Even though GH secretion was not tested at presentation, it is more than likely that the patient had GH deficiency. Management schemes for pituitary tumor apoplexy should address systemic, neurological, and endocrinological abnormalities. Patients presenting with clinical symptoms consistent with apoplexy require immediate medical attention, thorough clinical evaluation and continuous monitoring. Some of the most important interventions that must be urgently addressed in a patient with suspected pituitary tumor apoplexy are corticosteroid replacement and vigorous supportive measures to ensure hemodynamic stability (1).
Challenging cases in endorinology by Mark E Molitch
Categories: Nonfiction 6