A 30-year-old woman complains of headache, visual disturbances, deepening of the voice, and generalized weakness. She repos amenorrhea for the past year and states that she recently required a larger shoe size. Laboratory studies show impaired glucose tolerance. What other procedure would be useful for establishing your diagnosis?
CBC with differential count
CT scan of the abdomen
MRI of the sella turcica
Test for serum 21-hydroxylase
- Given clinical features suggests the diagnosis of acromegaly which can be d/t Pituitary adenoma. Pituitary adenomas - Range from small lesions that do not enlarge gland to expansive tumors that erode sella turcica & impinge on adjacent cranial structures. Hence MRI of sella turcica can be useful to diagnose these tumors. - Adenomas < 1 cm diameter- Microadenomas (no symptoms) - > 1 cm- Macroadenomas- Mass effect : Impingement on optic chiasma causing bitemporal hemianopsia, Loss of central vision, Oculomotor palsies when tumor invades cavernous sinuses Severe headaches. - Large adenomas may invade hypothalamus -Loss of temperature regulation, hyperphagia & hormonal syndromes because they interfere with normal hypothalamic input to pituitary. - Symptoms of acromegaly- Facial changes, goiter, barrel chest, abnormal glucose tolerance, male sexual dysfunction, menstrual disorders in women, degenerative ahritis, peripheral neuropathy & thickened skin.
Miscellaneous