A 14 year old girl, history of joint pains and heart disease in the past presented with abnormal movements in her hands while awake. Observe the movements in the video clipping.
A lady presenting with tightening of her footewear
Courtesy: Department of Endocrinology, CMC, Vellore.
HISTORY
A 28-year-old lady presents with tightening of her footwear over a period of 3 years. She is otherwise keeping well other than the fact she has oligomenorrhoea once in 3-4 months for the last 2 years.
ON EXAMINATION
On examination she has mild central facial coarsening, large hands and feet. Breast development is normal and pubic and axillary hair are normally staged.
INVESTIGATIONS
The full blood count and basic biochemistry are normal. Hormonal evaluation was performed. The results are as follows:
She is posted for neurosurgery within a fortnight. Unfortunately, a week prior to the destined date, she developed severe headache, blurring of vision and diplopia. Her picture within 12 hours of development of these her symptoms is shown below. She is posted for emergency surgery.
2. What diagnosis do the clinical features point to?
3. What would have been the reason for her acute symptoms?
HISTOPATHOLOGY
Histopathology of the biopsied tissue is shown below.
4. What are the histopathological findings ?
5. Why is emergency surgery indicated in this patient?
6. What are some of the complications that occur with this condition?
7. Which of the following statements is false?
Emergency surgery was required.
Octreotide therapy may be required post operatively.
Insulin tolerance testing is not indicated at a subsequent point in time.
The elevated prolactin is likely to be due to stalk compression.
The patient is probably oestrogen deficient.
REFERENCES
Nishizawa S, Ohta S, Yokohama T, Uemura. Therapeutic strategy for incidentally found pituitary tumors ("pituitary incidentalomas"). Neurosurgery 1998, 43:6, 1344-50.
Bates AS, Hoff WV, Jones PJ, Clayton RN. The effect of hypopituitarism on life expectancy. J Clin Endocrinol Metab 1996, 81, 1169-72.
Rosen T, Bengtsson B. Premature mortality due to cardiovascular disease in hypopituitarism. The Lancet 1990, 336, 285-88.
Veldhuis JH, Hammond JM. Endocrine function after spontaneous infarction of the human pituitary: Report, review, and reappraisal. Endocrine Rev 1980,1,100-107.
Fuchs S, Beeri R, Hasin Y, Weiss AT, Gotsman MS, Zahger D. Pituitary apoplexy as a first manifestation of pituitary adenomas following intensive thrombolytic and antithrombotic therapy. Am J Cardiol 1998, 81, 110-1.
Oo MM, Krishna AY, Bonavita GJ, Rutecki GW. Heparin therapy for myocardial infarction: an unusual trigger for pituitary apoplexy. Am J Med Sci 1997, 314, 351-3.
Acknowledgement: Submitted by Dr. Nihal Thomas, Department of Endocrinology, CMC, Vellore, from Pituitary passions by Nihal Thomas, Chrisopher White.
