ESR[045] Cases studies, Reproduction 1 and 2

Question 1

1. She has visual field loss in the exterior regions of both visual fields. What is you assessment of this condition?

Answer 1

•The visual field defect detected bilateral hemianopia.

Question 2

2. Where would the lesion be located?

Answer 2

Question 3

3. What pathology would the lesion suggest?

Answer 3

Question 4

4. What is your suspected diagnosis?

Answer 4

• Prolactinoma

•Non functional pituitary adenoma

Question 5

5. Which additional questions might you want to ask to support this diagnosis ?

Answer 5

• Galactorrhoea

• Headaches

• Oligomenorrhoea

Question 6

6. Serum prolactin was 40,000 mU/L. What treatment is usually given?

Answer 6

Question 7

7. If the hormonal profile for prolactin was not significantly elevated what would have been your course of action?

Answer 7

•The most likely diagnosis would have been a large non-functional pituitary tumor and transsphenoidal surgery would have been the best option. Treatment with long-acting somatostatin analogues can also be used to see if tumor shrinkage can be achieved.

Question 8

1. The treating team suspect a diagnosis of Congenital Adrenal Hyperplasia what do you expect baby G’s karyotype to be ?

Answer 8

• Chromosomal analysis reveals baby G has a 46 XX genotype.

• XY individuals would show a penis and no clitoris and not be affected by the insignificant changes in androgens associated with CAH.

Question 9

2. What has caused the clitoromegaly?

Answer 9

Question 10

3. Baby G is scanned and found to have ovaries and no testes, why?

Answer 10

Question 11

4. Baby G is found to have a congenital defect of the enzyme 21bhydroxylase. What hormone replacement therapy would be given?

Answer 11

Question 12

5. Would you raise baby G as a girl or boy?

Answer 12