PI He is a 43 year old man Who visited his family physician because of unilateral gynicomastia and pain 8 years ago No history of liver or kidney disease He had no history of chest ID: 934526
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Slide1
CC
:
Pituitary adenoma follow up
PI :
He is a 43 year old man Who visited his family physician because of
unilateral
gynicomastia
and pain 8 years ago.
No history of liver or kidney disease.
He had
no history of
chest
trauma.
He did not complain of headache, visual field or visual acuity defect, decreased libido, impotence, or
galactorrhea
.
On physical exam breast mass or axillary lymphadenopathy was not detected.
Slide2Slide3Oct. 2007
Slide4Dostinex
was started 0.25 mg twice weekly with the diagnosis of pituitary
microprolactinoma
.
He
stopped the treatment after one year because of decreased concentration.
He
underwent prolactin and LH measurement and brain MRI every 1-2 years but he refused to start
Dostinex
again .
Slide5Date
PRL
LH
Total
Testostrone
Free
Testostrone
Sept 2007
55 µg/L
1 IU/L (1.2-8.6)
5.1
nmol
/L (7.3-23.5)
12.5
Pmol
/L (31-94)
Feb 2008
7.2
3.1
25
Jul 2008
43
2
23.8
Jan 2009
108
2
3.8
Jul 2009
8.3
2.4
11.7
May 2010
87.7
2.7
4.1
Nov
2010
19.4
2.3
6
Slide6Aug. 2008
Slide7Aug. 2010
Slide8Aug. 2014
Slide9Now He dose not complain of headache, visual field or visual acuity defect, impotence,
gynicomastia
, or
galactorrhea
.
He complains of
decreased
libido
from one year ago.
He complains of some increasing skin tags on his neck from 2 years ago . He feels his hands enlarged in recent year and also tongue enlargement.
He dose not report any change in his shoes size .
Slide10PMH :
Neg
FH :
Neg
He has three children.
DH :
Exsmoker
1-2 pack year up to 18 years ago .
He
drinks alcohol occasionally .
Slide11PE :
PR : 80 BP : 125/80
Head
and neck :
Mild frontal bossing, skin tags on his neck
. No
prognatism
.
Chest
:
Nl
Abdomen
:
No
hepatosplenomegaly
.
Extremities :
No arthritis or joint deformities, mild hand enlargement .
Slide12Slide13Slide14Slide15Azar 94:
Slide16Azar 94:
Slide17Dey 94:
Slide18ECG :
Nl
CXR : No cardiomegaly
Total colonoscopy :
Nl
Slide19Slide20Slide21Slide22Slide23Slide24Slide25Slide26Azar 94
Slide27Slide28Slide29Problem List :
Pituitary
macroadenoma
Tongue enlargement
Skin
tags
Hand enlargement
Hyperprolactinemia
Elevated IGF1 and
GH
Low LH and testosterone
Mild partial central hypothyroidism
Low cortisol