by dr Zakeri dr Ghavam Patient history 32 yo man Born in Kermanshah amp live in Tehran Complains of decreased libido Source of history patient reliable Medical History and Physical Examination ID: 929680
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Slide1
Slide2Slide3Endocrine Grand Rounds
by
dr
Zakeri
,
dr
Ghavam
Slide4Patient history
32 y/o man
Born in Kermanshah & live in Tehran
Complains
of decreased libido
Source of history : patient , reliable
Slide5Medical History and Physical Examination
Slide6PI:
32 y/o man
decreased libido form 2 years ago
Fatigue & tiredness from 2 years ago
Skin changes , such as oily skin , acne from 2 years ago
Weight gain from 2 years ago
Deeping of the voice
Loud snoring
Slide7PI:
R
ecurrent
self limiting attacks
of cold sweating &
flushing during
day
from 2 years ago
Duration of each attack :10 to 20 seconds
Transient
blurred vision & diplopia & visual hallucinations
Panic
attack
Paresthesia in hands & feet
Feeling nausea during attacks (
without
vomiting )
Slide8PI:
Other symptoms as other says to him
include:
Large, prominent facial
features
such as nose & lower jaw
Abnormally large hands & feet (change in shoe size)
Slide9Pas
t
Medical
, Family, Drug, Social
History:
PMH:- , surgical hx :
trans-cranial surgery
Khordad 1398
FH: Dm in father
DH: Amp
Sandostatin
LAR (20
mg/
monthly)
Amp Testosterone (250
mg/weekly
)
Tab Cabergoline (0.5
mg/
three times a week )
Tab Prednisolone (5
mg/
daily)
Tab levothyroxine ( 50
micg
/ daily )
HH: -
Social hx : educated family, married , one child (2.5 year old )
Education : master
Occupation : clerk
Slide10Review of Systems
Constitutional symptoms:
Lack of energy(
+
), unexplained weight gain (
+
), sweats(
+
),
Ears, nose, mouth, throat:
Difficulty with hearing(-), ringing in ears (-) ,tongue enlargement (
+
),nose enlargement (
+
),, teeth space(-),
deeping
of the voice (
+
),
Cardiovascular:
palpitation(
+
),
Respiratory:
loud snoring (
+
)
Gastrointestinal:
Negative
Genitourinary:
impotence(-),
Slide11Review of Systems :
Musculoskeletal
.proximal
muscle weakness (-), abnormally large hands & feet (
+
),
prognathism (
+
)
Integumentary:
oily skin (
+
),acne(
+
),thick & coarse skin (-) ,
hair loss (
+
), striae(-),
Neurological:
Frequent headaches(-), double vision(
+
),blurred vision(
+
),visual hallucinations(
+
)decreased visual field (
+
), weakness(
+
), dizziness(-), loss of consciousness(-), paresthesia hands & feet (
+
),
Slide12Review of Systems :
Psychiatric:
Negative
Endocrine:
decreased libido (
+
),flushing (
+
),
Galactorrhea (
+
)
Hematologic/Lymphatic:
Negative
Allergic/Immunologic:
Negative
Slide13Physical Examination :
GENERAL APPEARANCE:
32
y/o man who is awake and alert.
VITALS
BP: 125/80 mmHg, PR: 75/min, RR: 16/min,
oT
: 36.8
BMI : 23 -
28
HEENT
Head and NECK :Scar of craniotomy in right frontotemporal , hair loss in frontal line ,prominent
forehead,prognathism,No
moon face, N0 plethora ,No
acantosis
nigricans,No
supraclavicular fat pad
Thyroid was normal size without nodule
No LAP
THORAX & BACK : No kyphosis ,
LUNGS : Clear
HEART : Normal
ABDOMEN : No striae , no organomegaly
Slide14Physical Examination :
Extremities :
Upper : Normal (range of motion , muscle tone , pulses )
Lower : Normal (range of
motion,muscle
tone, pulses )
No fasciculation or atrophy
Acral
enlargement : large hands & feet(
+
)
Force of muscles : 5/5
Physical Examination :
Neurologic Exams :
Upward
, downward, outward
movements of the right eye were
impaired
, ptosis
(-)
Normal DTR
Phalen test (-)
Genitalia :
P5G5
Slide16Slide17Slide18Slide19Slide20Slide21Slide2298.3
Slide2398.3.23
IGF 1=1329 ng/ml
Testosterone=
0.2
ng/ml
GH=
44 mic/l
LH=??
Prolactin=23 ng/ml
TG=94 mg/dl
Cortisol=18 micg/dl (Am)
CHOL=91 mg/dl
TSH=2.6
LDL=31 mg/dl
TT4
= 13 micg/dl
HDL=41 mg/dl
TT3=1.5
ng/ml
FBS=118 mg/dl
SG
98/3/23
1018
98/3/24
1016
98/3/24
1010
98/3/25
1007
98/3/26
1007
98/3/26
1007
98/3/27
1017
Slide24Na=140
K=4.4
Na=142
K=4
Na=135
K=3.7
Na=138
K=4.1
Na=137
K=4.2
Slide25Post
POST OP
Slide26Slide27Slide28Slide29Work up
Operation of trans craniotomy
25 Khordad 1398
Discharge from hospital with 30 Khordad 1398
Tab Cabergoline (0.5
mgr
/ once a week)
Tab Prednisolone (5
mgr
/ daily)
Tab levothyroxine ( 50
micgr
/ daily )
Brain Radiotherapy
2.4.1398 to 7.5.1398
Slide30POST RADIOTHERAY
Slide31Slide3298.11.30
IGF1=1163 ng/ml
GH=26.6
mic/l
LH=1.3
Testosterone=0.66 ng/ml
FSH=1.6
Cortisol=11.7 mic/dl
(AM)
Prolactin=1
ng/ml
TSH=0.7
FT4=19.8 pmol/l
Slide3399.4.2 99.6.18
GH
=
40 mic /l
IGF1=2362 ng/ml
IGF1
= 726 ng /ml
Testosterone=6.9 ng/ml
Testosteron
= 8.4 ng / ml
Prolactin=1.1 ng/ml
LH=0.1
TSH=0.9
FSH =0.3
FT4=28.5 pmol/l
Cortisol=7.8 micg/dl
(AM)
Slide3499.10
IGF1 =1035 ng
/
ml
GH = 76
mic / l
LH = 0.1 IU /L
Testosteron = 4.8
ng /ml
FSH = 0.1 IU /L
TSH = 0.26
uIU/ml
Prolactin = 0.04 ng /ml
F T4 = 10 pmol/l
Cortisol
= 12.75 mic /dl
FBS
= 113 mg/dl
Slide3599.10
Slide36Slide3799.10
Slide38Thanks for Your Attention