C h a p t e r 3 2
Disorders of Endocrine Control of Growth and Metabolism
791
R E V I EW E X E R C I S E S
1.
A 59-year-old man was referred to a neurologist
for evaluation of headaches. Subsequent MRI
studies revealed a large suprasellar mass (2.5 × 2.4
cm), consistent with a pituitary tumor. His history
is positive for hypertension and, on direct inquiry,
he believes that his hands are slightly larger
than previously, with increased sweating. Family
history is negative, as are weight change, polyuria
and polydipsia, visual disturbance, and erectile
dysfunction. Subsequent laboratory findings reveal
a baseline serum GH of 8.7 ng/mL (normal is 0
to 5 ng/mL), which is unsuppressed after oral
glucose tolerance testing; glucose intolerance; and
increased IGF-1 on two occasions (1044 and 1145
μ
g/L [upper limit of normal is 480
μ
g/L]). Other
indices of pituitary function are within the normal
range.
A.
What diagnosis would this man’s clinical
features, MRI, and laboratory findings
suggest?
B.
What is the reason for asking the patient about
weight change, polyuria and polydipsia, visual
disturbance, and erectile dysfunction?
C.
How would you explain his impaired glucose
tolerance?
D.
What are the possible local effects of a large
pituitary tumor?
2.
A 76-year-old woman presents with weight
gain, subjective memory loss, dry skin, and cold
intolerance. On examination she is found to have
a multinodular goiter. Laboratory findings reveal a
low serum T
4
and elevated TSH.
A.
What diagnosis would this woman’s history,
physical, and laboratory tests suggest?
B.
Explain the possible relationship between the
diagnosis and her weight gain, dry skin, cold
intolerance, and subjective memory loss.
C.
What type of treatment would be indicated?
3.
A 45-year-old woman presents with a history
of progressive weakness, fatigue, weight loss,
nausea, and increased skin pigmentation
(especially of creases, pressure areas, and
nipples). Her blood pressure is 120/78 mm Hg
when supine and 105/52 mm Hg when standing.
Laboratory findings reveal a serum sodium
of 120 mEq/L (normal is 135 to 145 mEq/L),
potassium level of 5.9 mEq/L (normal is 3.5 to 5
mEq/L), and low plasma cortisol and high ACTH
levels.
A.
What diagnosis would this woman’s clinical
features and laboratory findings suggest?
B.
Would her diagnosis be classified as a primary
or secondary endocrine disorder?
C.
What is the significance of her darkened skin?
D.
What type of treatment would be indicated?
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