year-old woman had an 8-year history of enlargement of her hands, feet, and faci
ID: 3507050 • Letter: Y
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year-old woman had an 8-year history of enlargement of her hands, feet, and facial long with excessive perspiration and oligomenorrhea: she denied galactorrhea or sellar enlargement. Visual field changes in vision. A lateral skull roentgenogram showed mild testing was normal, and a CT scan showed an int 105 ng/ml and did not change following glucose ingestion. A diagnosis of a made. She received 60Co external radiotherapy (5,000 rads) to her pituitary gland. rasellar tumor. The basal serum GH level was cromegaly was teen months after radiation therapy, there was no change in her acromegalic features and she still to become 35 perspired freely. Although her menses had become regular, she had been unable pregnant despite 2 years of unprotected intercourse. Her serum GH level was now ng/ml, her serum PRL level was 16 ng/ml, and her free T4 index was 8.5. After injection of TRH (500 g i.v ), her serum GH level rose from 36 ng/ml to 61 ng/ml, her serum PRL level rose from 16 ng/ml to 26 ng/ml, and her serum TSH level rose from 1.1 HU/ml /ml to 15 She was given bromocriptine, 15 mg/day for 6 months. While taking the drug, she noted less perspiration and a subjective shrinkage of her extremities, manifested by looser rings. Although her serum GH level did not change appreciably during bromocriptine therapy about 29 ng/ml, her serum PRL level fell toExplanation / Answer
Acromegaly is a hormonal disorder that results from too much growth hormone in the body, pituitary produces excess amount of growth hormone. Swelling of hand, feet, change in facial features are all early signs of acromegaly.Acromegaly can also cause menstrual irregularities and infertility.
The full effect of radiation therapy may not occur for many years, though the hormone levels might improve, additional treatment or medication is necessary for complete treatment of acromegaly.At this stage she was unable to be pregnant, the reason could be high level of prolactin in her body, indicated by high level of serum PRL level
Next she was treated with Bromocriptine. Bromocriptine belongs to group of medicine known as ergot alkaloids, which is used to treat acromegaly, these drugs are used to lower the levels of growth hormone and IGF levels,though it reduces the level of GH it does not completely supress it.
Bromocriptine blocks the release of hormone called prolactin from pituitary gland, this could be the reason why she became pregnant, because high level of prolactin is responsible for her non pregnancy.
After she became pregnant the drug Bromocriptine was dicontinued, because bromocriptine increases the blood pressure in pregnant women and moreover bromocriptine is known to expand the pituitary tumor in pregnant women.
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