/
Endocrine Grand Rounds Endocrine Grand Rounds

Endocrine Grand Rounds - PowerPoint Presentation

SocialButterfly
SocialButterfly . @SocialButterfly
Follow
342 views
Uploaded On 2022-07-27

Endocrine Grand Rounds - PPT Presentation

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

tab amp feet mic amp tab mic feet normal 1398 years hands skin prolactin micg cortisol physical daily tsh

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "Endocrine Grand Rounds" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

Slide2

Slide3

Endocrine Grand Rounds

by

dr

Zakeri

,

dr

Ghavam

Slide4

Patient history

32 y/o man

Born in Kermanshah & live in Tehran

Complains

of decreased libido

Source of history : patient , reliable

Slide5

Medical History and Physical Examination

Slide6

PI:

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

Slide7

PI:

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 )

Slide8

PI:

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)

Slide9

Pas

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

Slide10

Review 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(-),

Slide11

Review 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 (

+

),

Slide12

Review of Systems :

Psychiatric:

Negative

Endocrine:

decreased libido (

+

),flushing (

+

),

Galactorrhea (

+

)

Hematologic/Lymphatic:

Negative

Allergic/Immunologic:

Negative

Slide13

Physical 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

Slide14

Physical 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

Slide15

Physical Examination :

Neurologic Exams :

Upward

, downward, outward

movements of the right eye were

impaired

, ptosis

(-)

Normal DTR

Phalen test (-)

Genitalia :

P5G5

Slide16

Slide17

Slide18

Slide19

Slide20

Slide21

Slide22

98.3

Slide23

98.3.23

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

Slide24

Na=140

K=4.4

Na=142

K=4

Na=135

K=3.7

Na=138

K=4.1

Na=137

K=4.2

Slide25

Post

POST OP

Slide26

Slide27

Slide28

Slide29

Work 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

Slide30

POST RADIOTHERAY

Slide31

Slide32

98.11.30

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

Slide33

99.4.2 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)

Slide34

99.10

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

Slide35

99.10

Slide36

Slide37

99.10

Slide38

Thanks for Your Attention