BJ is a 54-year-old attorney who for several months has been experiencing genera
ID: 3505101 • Letter: B
Question
BJ is a 54-year-old attorney who for several months has been experiencing generalized headaches that have responded poorly to nonnarcotic analgesics. He is also experiencing visual disturbances, including blurred vision and double vision. On questioning, BJ reports that he has gained 20 pounds over 2 years despite having had no change in activity or eating patterns. About his weight gain, BJ jokes, “I guess it’s all in my feet. I had to buy new shoes, and my shoe size went from a size 10 to a size 12.” It was determined that BJ should have a CT scan of his head to assess for a pituitary adenoma resulting in the hypersecretion of growth hormone.
What information from the above scenario would support this possible etiology?
What other signs or symptoms might be apparent if BJ does indeed have a pituitary adenoma?
BJ is diagnosed with pituitary adenoma and undergoes a transsphenoidal hypophysectomy to remove the tumor. After surgery, he has huge urinary outputs of 500 to 600 ml/hr. What is the most likely cause of his high urine output? What other clinical data support this diagnosis?
BJ receives subcutaneous 1-deamino-8-d-arginine vasopressin (ddAVP) to manage his high urine output. What is the rationale for this therapy? How can effectiveness be assessed?
It is expected that after BJ’s transsphenoidal hypophysectomy, all of his anterior pituitary hormones will be deficient (panhypopituitarism). What type of hormone replacement will be needed?
What information should be given to BJ about the expected duration of hormone therapy and monitoring of treatment efficacy?
During periods of stress, BJ is likely to require an adjustment in hormone therapy. Which hormone is most critical and why?
Explanation / Answer
Pituitary adenoma causes severe headache,increase in weight because of over secretion of growth hormones.double vision[due to compression of optic nerve by tumours]can be caused by tumoursof pituitary that is pituitary adenoma.Feet enlargment is due to oversecretion of growth hormone produced by pitiutary gland
bitemporal hemianopia,headache,weight gain are common sign and symptoms of pitiutary adenoma.it can also lead to thyroid hormone disorders,androgen hormones disorders etc
huge urine output after surgery is due to post operative diabetic insipidus.he will also be having excessive tirst.water deprivation test,urine analysis can help in diagonosis of the condition.
ddAVP is a synthetic anti diuretic hormone.it act on kidney and blood vessels and reduce the loss of water through urine and thus decrese urine output.efffectiveness can be assessed by looking for urine volume of patient after administering ddAVP.
In panhypopituatirism,thyroid hormone replacement,sex hormone replacement,estrogen replacement in ladies etc have to be taken care of.
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