kpmle2
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A 32-year-old woman was involved in an automobile accident and briefly lost consciousness. MRI showed no traumatic damage to the brain, but a 4-mm hypointense area in the pituitary gland was noted. She is referred to you for further evaluation of the lesion after recovery from the accident. The patient reports normal menstrual cycles, no symptoms of Cushing’s syndrome or acromegaly, and no symptoms of hypothyroidism or hypoadrenalism. Physical examination is normal. The serum prolactin level and thyroid function tests are normal.
What is the most appropriate next step in this patient’s management?
A. Repeat MRI in 6 months
B. Refer for transsphenoidal surgery to remove the tumor
C. Refer for biopsy of the lesion
D. Obtain formal visual field examination
E. Start dopamine agonist therapy
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| jasmin
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a
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| neurom
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leave it alone and repeat an MRI in 6 months - A
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| tamerbashir
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A
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| RX 135
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can be D she had mva rule out hemianopsia
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| bax
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D
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| kpmle2
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The correct answer is A
Evaluate and manage a small incidental pituitary lesion.
This patient has an incidentally discovered small pituitary lesion. It is most likely a nonfunctioning adenoma, but it may be a cyst or other benign lesion. Such lesions are common, and their evaluation is controversial. In a patient with no symptoms of excess or deficient pituitary hormone secretion, a limited evaluation is the most cost-effective option. Measurement of serum prolactin is appropriate because prolactinomas are the most common type of pituitary tumor, and they may not cause symptoms if they are small and produce only modest amounts of prolactin. The other functioning pituitary tumors, including Cushing’s syndrome, acromegaly, and thyrotropin-secreting hormone tumors, are rare and usually cause symptoms. Therefore, it is not cost effective to evaluate an asymptomatic patient with a small lesion for these tumors. Formal visual field examination is not indicated because the lesion is small and not located near the optic chiasm. Referral for pituitary surgery or biopsy is not indicated because the lesion is not causing symptoms. In addition, fewer than 5% of these small lesions enlarge over time. Thus, immediate surgery is not indicated, but the patient should undergo periodic monitoring with MRI. If the result is unchanged in 6 months, imaging can be repeated 1 year later and then at increasing intervals as the natural history of the lesion becomes apparent.
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| Justice
Forum Fanatic
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A
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