Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MKSAP: 64-year-old woman with an incidental pituitary adenoma

mksap
Conditions
September 17, 2016
Share
Tweet
Share

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 64-year-old woman is seen for follow-up evaluation. Two weeks ago, she was in a car accident, and an incidental pituitary adenoma was found on a cervical spine CT scan. She has no residual injuries from the car accident.

She is otherwise healthy and takes no medications. She went through menopause at age 51. She has night sweats two to three times per month and occasional hot flushes. These have improved over the past decade and are not bothersome. She is not sexually active. She has never taken hormone replacement therapy. She has had no change in vision, headaches, or galactorrhea.

On physical examination, temperature is 37.5 °C (99.5 °F), blood pressure is 110/63 mm Hg, pulse rate is 82/min, and respiration rate is 14/min. BMI is 26. There is axillary and pubic hair loss. Visual fields are intact. There are no findings suggestive of Cushing syndrome or acromegaly.

Laboratory studies:

Estradiol <20 pg/mL (73.4 pmol/L)
Follicle-stimulating hormone 6.4 mU/mL (6.4 U/L)
Luteinizing hormone 3.2 mU/mL (3.2 U/L)
Prolactin 53 ng/mL (53 µg/L)
Thyroid-stimulating hormone 3.2 µU/mL (3.2 mU/L)
Thyroxine (T4), free 1.1 ng/dL (14.2 pmol/L)

Pituitary MRI shows a 7-mm adenoma in the anterior sella. The tumor is not invasive. It does not approximate the optic chiasm. The pituitary stalk is mid-line.

Which of the following is the most appropriate management?

A: Begin dopamine agonist
B: Gamma knife stereotactic radiosurgery
C: Repeat testing in 12 months
D: Transsphenoidal resection

MKSAP Answer and Critique

The correct answer is C: Repeat testing in 12 months.

No therapy is necessary at this time, and the patient should be retested in 12 months. The patient has a microprolactinoma, but she is postmenopausal. Luteinizing hormone and follicle-stimulating hormone levels are normally high in postmenopausal women because of ovarian failure; however, her levels are lower than expected, likely because the elevated prolactin is providing negative feedback. This causes hypogonadism but is not clinically relevant because she is already hypogonadal from normal menopause. She has minimal symptoms from menopause and is tolerating it well.

The prolactinoma was found incidentally. On MRI, it has no concerning features, and her other pituitary hormone levels are normal. Although no treatment is necessary for this asymptomatic patient, it is advisable to retest in 6 to 12 months to make sure that the tumor does not grow.

Dopamine agonists, such as cabergoline, are used to treat symptomatic prolactinomas, but it is not necessary in this asymptomatic patient.

Radiosurgery is not necessary. It is an option to treat pituitary tumors that are not amenable to standard surgery or cannot be fully resected, but it is not indicated for this asymptomatic patient.

Transsphenoidal resection of the pituitary tumor is overly invasive and unnecessary because she is doing well. In addition, first-line therapy for symptomatic prolactinomas are dopamine agonists, not surgery.

ADVERTISEMENT

Key Point

  • Microprolactinomas in asymptomatic patients do not require treatment; however, surveillance is recommended.

This content is excerpted from MKSAP 17 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 16 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Prev

I wish my doctor knew

September 16, 2016 Kevin 9
…
Next

When treating chronic pain, don't compromise your principles

September 17, 2016 Kevin 4
…

Tagged as: Endocrinology

Post navigation

< Previous Post
I wish my doctor knew
Next Post >
When treating chronic pain, don't compromise your principles

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

Related Posts

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 35-year-old woman with constipation

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 60-year-old woman with persistent constipation

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 45-year-old woman with type 2 diabetes mellitus

    mksap
  • 3 ways we’ve failed woman who breastfeed

    Joanna Buscemi, PhD
  • How one woman prevented a pharmaceutical disaster

    James Essinger and Sandra Koutzenko
  • A skin-lightening cream put a woman into a coma. How can that happen?

    Anna Almendrala

More in Conditions

  • Why gambling addiction is America’s next health crisis

    Safina Adatia, MD
  • How robotics are reshaping the future of vascular procedures

    David Fischel
  • How the shingles vaccine could help prevent dementia

    Marc Arginteanu, MD
  • Why removing fluoride from water is a public health disaster

    Steven J. Katz, DDS
  • What the research really says about infrared saunas

    Khushali Jhaveri, MD
  • How the cycle of rage is affecting physicians—and how to break free

    Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
  • Recent Posts

    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician
    • Why gambling addiction is America’s next health crisis

      Safina Adatia, MD | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
  • Recent Posts

    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician
    • Why gambling addiction is America’s next health crisis

      Safina Adatia, MD | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...