Porth's Essentials of Pathophysiology, 4e

791

Disorders of Endocrine Control of Growth and Metabolism

C h a p t e r 3 2

R E F E R E N C E S

R E V I EW E X E R C I S E S

1. Webb P, Baxter JD. Introduction to endocrinology. In: Gardner DG, Shoback D, eds. Basic and Clinical Endocrinology . 9th ed. New York, NY: Lange Medical Books/McGraw-Hill Medical; 2011:1–26. 2. Aron DC, Findling JW, Tyrrell JB. Hypothalamus and pituitary gland. In: Gardner DG, Shoback D, eds. Basic and Clinical Endocrinology . 9th ed. New York, NY: Lange Medical Books/ McGraw-Hill Medical; 2011:65–114. 3. Merino MJ, Quezado M, Rubin E, et al. The endocrine system. In: Rubin R, Strayer DS, eds. Rubin’s Pathology: Clinicopathologic Foundations of Medicine . 5th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008:933–955, 958–973. 4. Maitra A. The endocrine system. In: Kumar V, Abbas AK, Fausto N, et al., eds. Robbins and Cotran Pathologic Basis of Disease . 8th ed. Philadelphia, PA: Saunders Elsevier; 2010:1097–1129, 1148–1163. 5. Pickett CA. Diagnosis and management of pituitary tumors: recent advances. Prim Care. 2003;30:765–789. 6. Bevan J. Pituitary incidentalomas. Clin Med. 2013;13:296–298. 7. Toogood AA, Stewart PM. Hypopituitarism: clinical features, diagnosis, and management. Endocrinol Metab Clin North Am. 2008;37:235–261. 8. Molitch ME, Clemmons DR, Malzowski S, et al. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2006;91:1621–1634. 9. Styne D. Growth. In: Gardner DG, Shoback D, eds. Basic and Clinical Endocrinology . 9th ed. New York, NY: Lange Medical Books/McGraw-Hill Medical; 2011:129–162. 10. Cohen P, Rogol AD, Deal CL, et al. Consensus statement of the diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society of Paediatric Endocrinology Workshop. J Clin Endocrinol Metab. 2008;93(11):4210–4217. 11. Nwosu B, Lee MM. Evaluation of short and tall stature in children. Am Fam Physician. 2008;78(5):597–604. 12. Lee MM. Idiopathic short stature. N Engl J Med. 2006;354(24):2575–2582. 13. Guitosi-Kug RA, Cuttler L. Idiopathic short stature. Endocrinol Metab Clin North Am. 2005;34:565–580. 14. Laron Z. Laron syndrome (primary GH resistance): the personal experience 1958–2003. J Clin Endocrinol Metab. 2004;89:1031–1044. 15. Melmed S. Idiopathic adult growth hormone deficiency. J Clin Endocrinol Metab. 2013;98:2187–2197. 16. Nass R, Park J, Thorner MO. Growth hormone supplementation in the elderly. Endocrinol Metab Clin North Am. 2007;36:233–245. 17. Sesmilo G, Biller BM, Levadot J, et al. Effects of GH administration on inflammatory and other cardiovascular risk markers in men with GH deficiency. Ann Intern Med. 2000;133:111–122. 18. Root A. The tall, rapidly growing infant, child, and adolescent. Curr Opin Endocrinol Diab. 2001;8:6–16. 19. Hosana H, Cohen P. Hyperpituitarism, tall stature, and overgrowth syndromes. In: Kliegman RM, Stanton BF, St. Gemell JW, et al., eds. Nelson Textbook of Pediatrics . 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:1886:e1–e6. 20. Melmed S. Acromegaly. N Engl J Med. 2006;355:2558–2573. 21. Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am. 2008;37:101–122. 22. Fuqua JS. Treatment and outcomes of precocious puberty. J Clin Endocrinol Metab. 2013;98:2198–2207. 23. Styne D. Puberty. In: Gardner DG, Shoback D, eds. Basic and Clinical Endocrinology . 8th ed. New York, NY: Lange Medical Books/McGraw-Hill Medical; 2007:611–640.

1. A 59-year-old man was referred to a neurologist for evaluation of headaches. Subsequent MRI studies revealed a large suprasellar mass (2.5 × 2.4 cm), consistent with a pituitary tumor. His history is positive for hypertension and, on direct inquiry, he believes that his hands are slightly larger than previously, with increased sweating. Family history is negative, as are weight change, polyuria and polydipsia, visual disturbance, and erectile dysfunction. Subsequent laboratory findings reveal a baseline serum GH of 8.7 ng/mL (normal is 0 to 5 ng/mL), which is unsuppressed after oral glucose tolerance testing; glucose intolerance; and increased IGF-1 on two occasions (1044 and 1145 μ g/L [upper limit of normal is 480 μ g/L]). Other indices of pituitary function are within the normal range. A. What diagnosis would this man’s clinical features, MRI, and laboratory findings suggest? B. What is the reason for asking the patient about weight change, polyuria and polydipsia, visual disturbance, and erectile dysfunction? C. How would you explain his impaired glucose tolerance? D. What are the possible local effects of a large pituitary tumor? 2. A 76-year-old woman presents with weight gain, subjective memory loss, dry skin, and cold intolerance. On examination she is found to have a multinodular goiter. Laboratory findings reveal a low serum T 4 and elevated TSH. A. What diagnosis would this woman’s history, physical, and laboratory tests suggest? B. Explain the possible relationship between the diagnosis and her weight gain, dry skin, cold intolerance, and subjective memory loss. C. What type of treatment would be indicated? 3. A 45-year-old woman presents with a history of progressive weakness, fatigue, weight loss, Laboratory findings reveal a serum sodium of 120 mEq/L (normal is 135 to 145 mEq/L), potassium level of 5.9 mEq/L (normal is 3.5 to 5 mEq/L), and low plasma cortisol and high ACTH levels. A. What diagnosis would this woman’s clinical features and laboratory findings suggest? B. Would her diagnosis be classified as a primary or secondary endocrine disorder? C. What is the significance of her darkened skin? D. What type of treatment would be indicated? nausea, and increased skin pigmentation (especially of creases, pressure areas, and nipples). Her blood pressure is 120/78 mm Hg when supine and 105/52 mm Hg when standing.