Question

Endocrine System Case Study

PM is a 15-year-old young woman who started her menstrual period at age 11. Recently, she has been experiencing double vision, headaches, and amenorrhea. A skull MRI indicates a pituitary adenoma. Blood tests indicate low estrogen, progesterone, and TSH levels.

Case Study Questions

1. Discriminate the relationship of the pituitary gland to the optic nerve, its role in controlling sex hormones, and connection to thyroxin serum levels.
2. Examine the pathophysiology of adenoma.
3. Explain why this benign tumor must be surgically removed.
4. Appraise the manifestations that you would expect to see in PM caused by the reduced estrogen, progesterone, and TSH levels.
5. Examine the treatments necessary for the patient following surgery.

Answer 1

Relationship of pituitary gland to the optic nerve

the internal carotid arteries and the nerve that control eye movement lie on the side of the pituitary.optic chiasm is directly above the pituitary gland ,which is responsible for vision.when pituitary tumors grow they compress the above mentioned structures-so patient is experiencing blurred vision

.Relationship of pituitary gland in controlling sex.-Pituitary gland produces gonadotrophins(Luteinising hormone and follicle stimulating hormone)They act on Overies or testes to stumulate sex hormone production and egg and sperm maturity.

Relation to Thyroid--Pituitary gland stimulates Thyroid stimulating hormone which stimulate Thyroid gland to secrete Thyroid hormon.

Pathophysiology of pituitary adenomas.

Most pituitary tumors are sporadic but some arise as a component of genetic syndromes.Some specific genes have been idenified that predispose to pitutary neoplasia.But these are rarely involved in the pathogenessis of sporadic tumours..if tumor gets larger than about a centemeter across,it can grow upward where it can press on and damage nearby parts of brain

Why tumor should be removed?

Tumor should be removed to reduce the signs and symptoms of pitutory adenoma and its associated complications like blurred vision . The main treatment for many pituitary tumor is surgery-Type of surgeries are

anssphenoidal surgery-surgery is done through the sphenoid sinus

craniotomy-for larger or more complicated tumors

CLINICAL MANIFESTATIONS

headache

vision loss

signs and symptoms related to TSH -feeling cold,unintended weight loss or gain rapid or irregular heart beat,no menstrual periods,excessive sweating,nervousness or iritability

signs and symptoms related to estrogen and progestrom-irregular menstrual periods ,acne ,sexual dysfunction,lowered sperm count and loss of sex drive

post operatively

hormon analysis have to be done frequently or as prescribed

take medications as prescribed[like prednisone]

endocrinologist will monitor sodium and hormone levels in the weeks after surgery