Question

CASE STUDY D Pituitary Adenoma and Acromegaly C.M., age 20 years, was admitted to the emergency department with severe headache, photophobia, drowsiness, and slight neck rigidity, suggestive of meningitis. Her medical history indicated good general health. She had been treated for carpal tunnel syndrome 3 years before, and she had noted an increase in hand and foot sizes over the past several years. In the past week, she had experienced severe headaches associated with nausea and vomiting. Tests on CSF did not confirm meningitis. Blood tests indicated low levels of thyroxine, cortisol, and gonadotropins, but high levels of growth hormone. Radiographic tests showed a space occupying lesion in the sella turcica. A diagnosis of pituitary adenoma with acromegaly was established. The acute episode had resulted from infarction of the pituitary gland (pituitary apoplexy) C.M. recovered from the infarction and was discharged from the hospital. The infarction had reduced the GH secretion to some extent. Thyroxine and cortisol levels were low normal; no replacement therapy was recommended at this time. 1. Define adenoma, and describe the location of the pituitary gland. 2. Explain the rationale for the neurologic signs and symptoms leading to admission (see Chapter 14) 3. Explain the effects of acromegaly in CM. How long was the adenoma likely present? 4. Explain the low blood levels of thyroxine, gonadotropins and cortisol. Two years later C.M. was experiencing temporary paresthesias in both hands in the morning. Also headaches had become more frequent and were accompanied by visual signs such as spatial distortion. Cold sensitivity and fatigue persisted. She felt her

Answer 1