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sarika
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02/22/07 - 03:10 PM

48 yrs old man with pituatary adenoma seen on MRI. BP 165/99. Most appropriate initial step in amnagement.

1. somatostatin analogues

2.radiation.

3.antihypertensives

4.transphenoidal resection of adenoma

5.surgical reduction of the jaw

robin082006
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02/22/07 - 03:17 PM

Incomplete q, we should know the effect of this tumor first in order to decide the treatment.

this patient has grade II hypertension---> treat hypertension

3.antihypertensives

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Aashi
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02/22/07 - 03:34 PM

Probably this is Acromegaly------->TOC--->is transphenoidal resection of adenoma

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sarika
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02/22/07 - 03:45 PM

So the thing is should we treat the hypertension first before we attempt the rescetion?

mjl1717
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02/22/07 - 04:45 PM

sarika wrote:
So the thing is should we treat the hypertension first before we attempt the rescetion?

in general in surgery you ALWAYS want to stabilize your patients vital signs before putting him under the knife!!!

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sarika
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02/22/07 - 05:37 PM

Good mj1717 thats exactly what i thought (also because it said initial management) but unfortunately Kaplan qbank doesnt agree with us....ANswer given was 4.transphenoidal resection of adenoma sad

Aashi
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02/22/07 - 05:59 PM

well..y i picked SURGERY here is coz 1) the pt is NOT in a HTN crisis-->so need for any urgent management for this BP 2) in any cases of HTN, just one reading is just NOT enough to start on drugs and 3) HTN is a SYMPTOM in acromegaly , which can be treated with surgical resection of the adenoma, the CVS parameters usually normalise after the surgery..

Its the same case like a young pt who is hypertensive( probably due to fibromuscular dysplasia of renal arteries) and we all know the TOC is stenting and NOT drugs..

This is just my explanation..i would like to know what is kaplans q bank explanation on this sarika..Just want to know their reasoning as well..

Thanks and GL wink

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krsna
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02/22/07 - 06:35 PM

4 is the answer here

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