A 43-year-old man came for evaluation of a change from his usual migraine headache. The headache is more frequent and responds poorly to a previously prescribed medication (ibuprofen and sumatriptan). He denies fever, neck stiffness, and weakness. On physical exam, his vital signs and visual field test were normal. A pituitary MRI was done and showed suprasellar extension with no compression on the optic chiasm. Lab tests showed cortisol (469), normal TSH, and T4. What is the next step?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Measuring prolactin and IGF
Once a pituitary adenoma is found, the workup is MRI plus pituitary hormone levels, so you know whether the tumour is secreting. Cortisol, TSH and T4 are already normal. The axes still unchecked are prolactin and IGF-1 (GH). Prolactin especially changes management: a prolactinoma is treated medically first, while most other adenomas go to transsphenoidal surgery. Urgent surgery (B) is premature with no chiasm compression and no hormonal diagnosis. Cushing tests (C) are not first-line when cortisol is normal and there are no Cushingoid features. Six-month follow-up without workup (D) leaves possible hypersecretion untested.
ليش كل خيار صح أو غلط
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A
ليش صح
Once an adenoma is found the work-up is MRI plus pituitary hormone levels; cortisol, TSH and T4 are already normal, so prolactin and GH/IGF-1 are the levels still missing.
✓ Step Up To Medicine 6th Edition 2024 (Pituitary).pdf · p. 2 -
B
ليش غلط
Transsphenoidal surgery is indicated in most patients, except prolactinomas, which can be tried medically first, so hormone levels (prolactin) are needed before deciding.
✓ Step Up To Medicine 6th Edition 2024 (Pituitary).pdf · p. 2 -
D
ليش غلط
Observation is for microprolactinoma with normal menses or nonfunctioning microadenomas; this tumour extends suprasellarly and has changed the headache pattern, and its hormonal activity is unknown.
✓ RT - Pituitary.pdf · p. 3
- المصدر
- Step Up To Medicine 6th Edition 2024 (Pituitary).pdf · p. 2
- المحاضرة
- Pituitary Disorders · Endocrinology · Module B
- ظهر في
- MED43 ♀ Compre