Endo Case Studies 1

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Endo Case Studies 1
2012-01-24 18:16:31

Case studies for exam 1
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  1. Symptoms:
    -bitemporal hemianopsia (partial blindness or other visual disturbances)
    -growth retardation
    -possible diabetes insipidus
    -other pituitary deficiencies
    -most common during childhood
    • Craniopharyngioma
    • Cause - remnants of Rathke pouch (embryologic precursor of anterior pituitary)
    • Test - radiograph to detect calcified lesion in brain
    • Treatment - Surgical removal of adenoma
  2. Symptoms:
    -tall stature with long extremities
    -hyperextensible joints
    -arachnodactyly (long tapering digits)
    -ectopia lentis (dislocation of lenses)
    -detached retina
    -aortic valve incompetence
    -heart murmur consistent with mitral valve prolapse
    -spinal defomities
    -increased risk for dissecting aortic aneurysm
    -unusually hereditary (20% are sporatic)
    • Marfan Syndrome
    • Cause - mutation in fibrillin gene on chromosome 15
    • Test - physical examination
    • Treatment - spinal brace, aortic valve replacement if needed, beta-blockers, frequent eye examinations, angiotensin receptor blockers
  3. Symptoms:
    -tall stature in children
    -enlargement of hands, feet, skull and mandible
    -weight gain
    -insulin resistance resulting in hyperglycemia
    -cardiomegaly and cardiac failure
    -possible bitemporal hemianopsia or other visual disturbances
    • Acromegaly and Gigantism (children)
    • Cause - pituitary somatotropic adenoma
    • Test - lab tests reveal hyperglycemia and ingreased GH levels
    • Treatment - Octreotide (somatostatin analog to decrease GH release by feedback inhibition), surgical removal of adenoma
  4. Symptoms:
    -amenorrhea (missing periods)
    -delayed deep tendon reflexes
    -loss of pubic hair
    -possible bitemporal hemianopsia if caused by adenoma
    • Pituitary Cachexia
    • Cause - pituitary adenomas, Sheehan syndrome (ischemic necrosis of ant pit following postpartum hemorrhage), or other damage to pituitary
    • Test - blood tests reveals decreased FSH, LH, TSH, ACTH, and GH
    • Treatment - hormone replacement therapy, or surgical removal of adenoma if that's the cause
  5. Symptoms:
    -painless, reddish-purple, raised lesions
    -hemoptysis (coughing up blood)
    -lymphadenopathy (swollen lymph nodes)
    -dyspnea (sortness of breath)
    -abdominal pain and GI bleeding
    • Kaposi Sarcoma
    • Cause - unknown, associated with aids
    • Test - KSHV antibodies 70-90% of time, colonoscopy and bronchoscopy to assess possible visceral involvement
    • Treatment - reduce viral load and raise CD4 count with antiviral therapy; topical treament for limited disease, for systematic disease treat with chemo
  6. Symptoms:
    -irregular shaped lesion on skin
    -color change from brown to red/purple
    -growing in size
    • Melanoma
    • Cause - sunlight exposure, genetic predisposition
    • Test - biopsy, presence of S-100 tumor marker
    • Treatment - surgical excision, regional lymph node dissection if spread, if metastised consider IL-2 treatment