PakMediNet Discussion Forum : Medicine : Diagnosis required...
Diagnosis required...
A 69-year-old man presents with an acute severe headache.
Physical examination reveals an isolated left third cranial nerve
palsy. Laboratory studies show hyponatremia and abnormally
low levels of luteinizing hormone, follicle-stimulating hormone,
thyroid-stimulating hormone, adrenocorticotropic hormone,
testosterone, thyroxine, and cortisol.
What is the diagnosis?
Posted by: omeir_136 Posts: 4 :: 10-03-2008 :: | Reply to this Message
Re: Diagnosis required...The most probable diagnosis is some pituitary tumor needing proper investigations.
Posted by: zain Posts: 35 :: 11-03-2008 :: | Reply to this Message
Re: Diagnosis required...
This is a typical case of Pituitary Apoplexy (hemorrhage in the Pituitary tumor (macroadenoma)) resulting in Panhypopituitrism. Third nerve palsy can be a false localizing sign secondary to raised ICP. It may be a possibility that pituitary tumor causing pressure on 3rd nerve. Get an urgent MRI of the pituitary gland and brain.
This patient needs Steroids (stress dose)+ thyroxine first as a life saving measures. The cause ie tumor has to be removed or dulked surgically if possible. Later, once patient gets stable, he should also be started on Testosterone (after looking at his prostate and hemoglobin levels).
Thanks
Dr. Osama
Administrator
Endocrinologist
[Edited by docosama on 12-03-2008 at 09:23 AM GMT]
Posted by: docosama Posts: 333 :: 11-03-2008 :: | Reply to this Message
Re: Diagnosis required...
I agree Pituitary Apoplexy is a likely diagnosis. Besides hormonal replacement an urgent neurosurgical consultation is also required. These patients are at a high risk of visual loss secondary to pressure on the optic chiasm.
Nizam
Posted by: Nizam Posts: 82 :: 12-03-2008 :: | Reply to this Message