DrVirgo
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A 35 year old male presents with complaints of weakness and fatigue of one year's duration. He is anorexic and has lost interest in his activities. He also complains of cold intolerance and constipation. His BP is 98/72 Temp is 99F, Resp. are 14/min Pulse is 50/min. His skin is dry and rough, nails are brittle, and hair is thin. There is no hyperpigmentation of the skin. Delayed deep tendon reflexes are noted on neuro exam.
Lab studies show:
Hemoglobin 10.2
WBC 5000
Neut: 45%
Monocytes 5%
Eosinophils 10%
Basophils 1%
Lymphocytes 40%
Serum Na: 135
Serum K: 4.0
Which of the following is most consistent with this patient's findings?
A. Autoimmune destruction of adrenal glands
B. Adrenal Tuberculosis
C. Adrenal CMV infection
D. Adrenoleukydystrophy
E. Pituitary Tumor
Please EXPLAIN your answer!!! Thanks.
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| doc_clotaire
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A. Autoimmune destruction of adrenal glands
may be associated with other endocrine deficits (e.g hypothyroidism )
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| DrVirgo
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Nope... Please try again.
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| doc_clotaire
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I had the feeling that it was not gonna be that easy but I stil jumped 
Well , let s try again !
This is a male patient has clear cut Hypothyroidism , since all the choices here focus on Addison Disease ( primary adrenal failure ) which is very unlikely for this patient to have ( no hyperpigmentation , no hyperkalemia ) the only choice that can be related here is
E ... pituitary tumor ( central hypothyroidism ...secondary or tertiary ) due to damage of the hypothalamic pituitary axis .
I hope I don t screw up again 
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| dr.wad
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good one...
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| DrVirgo
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Yes, thats right the answer is: E. Pituitary Tumor
Explanation says that it is a Pituitary Tumor which leads to Glucocorticoid deficiency (Secondary Adrenal Insufficiency) and Hypothyroidism .. And since there is NO hyperpigmentation, this is indicative of Pit. Tumor instead of Addisons (Primary Adrenal Failure)... -in case of Addisons, there would be Increased ACTH and hyperpigmentation.
However my question is this: In case of a Pituitary Tumor, wouldn't the Pituitary Hormones like TSH and ACTH INCREASE instead of decrease? In another Q in UW, they said that Corticotroph Adenomas of the pituitary secrete ACTH and lead to Cushings (increased cortisol from the adrenals), and Thyrotroph Adenomas of the pituitary secrete TSH and lead to hyperthyroidism (increased secretion of thyroid hormone from the thyroid gland)...
So why is it the Reverse in this case???
Edited by DrVirgo on 02/26/08 - 10:26 AM
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| dr.wad
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DrVirgo ......pituitary tumor may be not functioning >>>compress the normal tissue>>impair hormone secretion.
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| DrVirgo
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dr.wad wrote:
DrVirgo ......pituitary tumor may be not functioning >>>compress the normal tissue>>impair hormone secretion.
Thats true in this case.
So pituitary tumors can be either functioning (producing MORE hormones than usual) or non-functioning, as you mentioned.
Which are more common? And in the case of functioning tumors will there be an increase in all Pituitary hormones?
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