Brad Johnson (BJ) is a 54-year-old diagnosed with pituitary adenoma He undergoes a transsphenoidal hypophysectomy to...

Brad Johnson (BJ) is a 54-year-old diagnosed with pituitary adenoma He undergoes a transsphenoidal hypophysectomy to remove the tumor.

Before surgery, what conditions might BJ’s pituitary adenoma precipitated?
After surgery, he has huge urinary outputs of 500 to 600 ml/hr. What is the most likely cause of his high urine output? What other clinical data would support this diagnosis?
BJ receives subcutaneous Desmopressin (DDAVP) to manage his high urine output. What is the rationale for this therapy? How can effectiveness be assessed?
It is expected that after his transsphenoidal hypophysectomy, all of BJ’s anterior pituitary hormones will be deficient (panhypopituitarism). What type of hormone replacement will be needed?

Expert Solution

1) Before surgery, Mr. BJ might have the condition of DNA mutation may leads to cells in the pituitary gland grow and devide uncontrollable. the exact cause is unkown rarely it cause due to history of family illness.

2) High urine output is due to deficiency or excess of ADH ( antidiuretic hormone) which is produced by pituitary gland , removal of gland leads to increased urine output.

supporting symptoms like muscle wasting , loss of libido

3) Desmopressin act as a selective agonist of V2 receptors expressed in the renal collecting duct to increase water re-absorption and reduce urine production. Desmopressin increases urine osmolality , decreased nocturnal total urine volume, reduced the ratio of nocturnal urine volume to whole day urine volume and decreased nocturnal voiding frequency.

4)Hormone replacement therapy include glycocorticoids. which helps to improve further condition and avoid complications.

Nightingale answered 3 months ago

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