1/4. acromegaly with moderate hyperprolactinemia caused by an intrasellar macroadenoma.BACKGROUND: A 31-year-old woman presented 12 months after discontinuing the oral contraceptive pill with progressive headache to her primary-care physician. She had previously presented with irregular menses to her obstetrician-gynecologist 4 months after discontinuing the oral contraceptive pill. Her serum prolactin levels were 153 microg/l and a pituitary MRI revealed a 13 mm intrasellar mass consistent with an adenoma. The patient was given 0.5 mg cabergoline twice weekly, and after 6 weeks her prolactin levels fell to 31 microg/l. After 6 months, however, she complained of persistent frontal headache and a repeat MRI revealed that the adenoma had increased in size to 16 mm. The patient was referred to an endocrinologist for further evaluation. INVESTIGATIONS: serum insulin-like growth factor 1 levels and growth hormone levels measured 2 h after ingestion of 75 g of oral glucose. diagnosis: acromegaly and hyperprolactinemia caused by a mixed-cell adenoma, secreting growth hormone and prolactin. MANAGEMENT: Trans-sphenoidal surgery followed by medical therapy with 20 mg intramuscular octreotide-LAR monthly.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Resolution of migraine following bromocriptine treatment of a prolactinoma (pituitary microadenoma).A 39-year-old male physician with a 27-year history of chronic severe migraine had a prolactin-secreting pituitary microadenoma diagnosed as an incidental finding following an automobile accident. Treatment of the prolactinoma with bromocriptine provided complete and lasting resolution of the migraine as well, suggesting a possible etiologic relationship between these two prevalent conditions, and the possibility of treating at least some cases of migraine with bromocriptine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. life-threatening conditions associated with male infertility.Most urologists' clinical experience is that infertility is a rare presenting sign of life-threatening medical disorders in men. Considering the current practice of infertile couples presenting to the gynecologist for initial evaluation and the popularity of assisted reproductive technology, many men are evaluated with a semen analysis alone and treatment instituted without urologic consultation. This may cause a delay in the diagnosis of a significant medical illness or misdiagnosis of a potentially treatable cause of male factor infertility. We reviewed the records of 1236 new male infertility patients presenting to Bowman Gray School of medicine and Baylor Medical College in an attempt to determine the frequency of significant medical disease in men presenting with infertility and whether any pattern of semen analysis findings was predictive of these disorders. Thirteen men, or 1.1% of the total population, were found to have a significant medical illness upon full urologic evaluation (Table 5). Testicular tumors were found in six, spinal cord tumor in one, brain tumors in three, genitourinary malformation in two, and a chromosomal abnormality in one. Interestingly, one of these patients was a physician with bilateral testicular cancer who had an abnormal semen analysis and had undergone multiple cycles of intrauterine insemination before referral. We could not identify a pathognomonic pattern on semen analysis that would allow us to predict the presence of medical illnesses in these 13 patients. Sperm counts ranged from azoospermic to almost normal semen parameters.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Diencephalic tumours presenting as behavioural problems in the workplace.Two patients presented with histories of significant behavioural disturbance and deteriorated work performance. Subsequent investigations confirmed the presence of a craniopharyngioma and a prolactinoma. Occupational physicians should consider excluding organic pathology in employees with histories of an unexplained marked change in work performance and behaviour.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |