Targeted Issues in Endocrinology Joshua S. Coren, DO, MBA, FACOFP
7/29/2015
Endocrine in 25 Minutes Joshua S. Coren, D.O., MBA, FACOFP Chair and Associate Professor, Family Medicine Rowan University School of Osteopathic Medicine
LMP = 4 Months Ago Home Pregnancy Tests Negative x 2 Menarche at Age 11 Regular Cycle until 4 Months Ago Weekly Headaches Occasional Galactorrhea on breast palpation Physical Examination = Normal Neuro / Musculoskeletal/ Reflexes = Normal Serum Prolactin = 1665 ng /mL (Normal Range = 2 29 ng/mL)
Case 1 Which of the following is the most likely cause of this patient’s elevated prolactin level? 1. 2. 3. 4.
Pituitary Adenoma Symptoms • Headache • Vision loss, particularly loss of peripheral vision • Nausea and vomiting • Fatigue • Weakness • Amenorrhea • Galactorrhea
• • • • • •
Cold intolerance Constipation Low blood pressure Body hair loss Sexual dysfunction Unintended weight loss or gain
Case 2 26 y.o. Female with Fatigue & Weight Gain - Irregular Menstrual Cycle
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Galactorrhea x 6 Months No Change in Vision Taking no Medications 2 Small Goiter Questions Dry Skin Bilateral Expressive Galactorrhea Normal Visual Fields Pregnancy Test = Negative Prolactin Level = 55 ng/ mL // Normal ( 2 = 20 ng/mL) Slight Enlargement of Pituitary Gland on MRI
Case 2 Which of the following is the most appropriate next step Which of the following is the next best treatment in management of this option? patient? 1) Dopamine Agonist Therapy
1) Administer bromocriptine
2) Re-measure serum prolactin
2) Use of Oral Contraceptives
3) Estrogen/Progesterone therapy 3) Administration of L-thyroxine 4) Serum TSH and Free T4
4) Resection of Pituitary Gland
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Case 3 16 year old female presents with concerns of “overactive thyroid” – Mother and Sister with similar condition
Which of the following are symptoms of hyperthyroidism? 1) 2) 3) 4)
Weight Gain Palpitations Dry Skin Constipation
Hyperthyroid Symptoms • • • • • •
Palpitations Heat intolerance Nervousness Insomnia Breathlessness Increased bowel movements • Light or absent menstrual periods
• • • • • • • •
Fatigue Fast heart rate Trembling hands Weight loss Muscle weakness Warm moist skin Hair loss Staring gaze
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Hypothyroid Symptoms • Fatigue • Weakness • Weight gain or increased difficulty losing weight • Coarse, dry hair • Dry, rough pale skin • Hair loss • Cold intolerance (you can't tolerate cold temperatures like those around you)
Case 4 51 y.o. female presents with 2 month history of palpitations, diaphoresis, & tremor. – 10 Pound Weight Loss – Appears Nervous on Examination – Taking no Current Medications – Tachycardia at 108 bpm – Enlarged / Non-Tender Thyroid Gland
Case 4 Which is the best initial test to evaluate the patients hyperthyroidism?
1) 2) 3) 4)
Serum TSH Serum Total T4 Serum Total T3 Thyroid – Stimulating immunoglobulin
