By Mark E. Molitch
Northwestern Univ., Chicago, IL. textual content, for the working towards endocrinologist, positive factors concise case experiences, unorthodox pondering generating powerful nonstandard ways, newest tools of analysis and therapy, and functional info for day-by-day use. DNLM: Endocrine Diseases--diagnosis.
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Additional resources for Challenging Cases in Endocrinology (Contemporary Endocrinology)
She is on prophylactic therapy for peptic ulcer disease. REFERENCES 1. Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med 1997;336:1224–1234. 2. Zajicek JP, Scolding NJ, Foster O, Rovaris M, Evanson J, Moseley IF, Scadding JW, Thopson EJ, Chamoun V, Miller DH, McDonald WI, Mitchell D. Central nervous system sarcoidosis. Diagnosis and management. QJM 1999;92:103–117. 3. Lower EE, Broderick JP, Brott TG, Baughman RP. Diagnosis and management of neurological sarcoidosis. Arch Intern Med 1997;157:1864–1868.
The electrocardiogram was reported as low voltage with sinus bradycardia. MRI of the pituitary with contrast showed meningeal enhancement in the region of the optic chiasm and a normal-appearing pituitary stalk. Neuroophthalmologic evaluation revealed granulomas in the tarsal conjunctiva but no uveitis. Dynamic studies of pituitary hormone secretion were done, as shown in the Fig. 1. Briefly, they showed an elevated serum prolactin level on multiple occasions, associated with partial hypopituitarism, with loss of gonadal, thyroidal, and adrenal functions.
Arafah BM, Taylor HC, Salazar R, Saadi H, Selman WR. Apoplexy of a pituitary adenoma after dynamic testing with gonadotropin-releasing hormone. Am J Med 1989;87:103–105. 6. Maccagnan P, Macedo CLD, Kayath MJ, et al. Conservative management of pituitary apoplexy: a prospective study. J Clin Endocrinol Metab 1995;80:2190–2197. 7. Arafah BM. Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 1986;62:1173–1179. CASE #4: METASTASIS TO PITUITARY Case Presentation A 55-yr-old man presented to the neurology service with, a 2-d history of diplopia and headaches.
Challenging Cases in Endocrinology (Contemporary Endocrinology) by Mark E. Molitch